James Purnell: I wish to start by paying tribute to my predecessor and the radical programme of welfare reform that he established. I am honoured to be building on the work that he achieved.
	I congratulate the centre that my hon. Friend mentioned and reassure her that volunteering and the voluntary sector are at the heart of our programmes to get people back into work. Volunteering can teach people important skills, which bring them closer to the labour market, and the voluntary sector plays a growing role in getting people who are on incapacity benefit and those in the new deal back into work.

James Plaskitt: My hon. Friend will know that I have visited the Plymouth office, where I discussed with the staff both the agency's current performance and the move to the new commission arrangement. I am pleased to report that the staff are behind the work that the Department is doing and fully support the move to the commission. In so far as they have any reservations about their status, which they raised when I visited, we have been able to resolve the matter by telling the staff that they will remain Crown employees. The staff fully support the changes that we are making, because they want to be part of a child maintenance arrangement that works.

James Plaskitt: I can certainly supply my right hon. Friend with that information. He is right that there are unacceptable waits in some cases—after all, 38 per cent. of non-resident parents are failing to pay part or all of their maintenance assessment. That is clearly not acceptable, but we are dealing with people who will sometimes go to the most extraordinary lengths to avoid facing up to their clear responsibility, and the agency cannot always do everything that it would like to in going after them. However, in addition to the improvements to which I have referred, the agency is now taking a record level of enforcement action to go after the non-resident parents who will not pay, with record numbers of charging orders, suspended committal sentences, removals of driving licences and deduction from earnings orders, as well as doing more than ever before to collect arrears.

James Purnell: We have made considerable progress in tackling poverty. Since 1998-99, the number of pensioners in relative poverty has fallen by more than 1 million, and the number of disabled individuals living in relative poverty, after housing costs, has fallen by about 900,000. There are now 600,000 fewer children living in relative poverty, before housing costs, than there were in 1998-99.

Tony Baldry: The Department's own statistics on households on below-average incomes show that, since 2001, the bottom 10 per cent. of families are becoming worse off. They are going backwards, and getting poorer. How has that come about?

Stephen Timms: I understand that the target has been reached in Scotland. As my right hon. Friend the Secretary of State said, we remain committed to making further progress and to the abolition of child poverty entirely by 2020. We have made good progress. The number of children growing up in poverty has fallen by 600,000 since 1997, having doubled under the policies of the Conservatives.

Stephen Timms: I thank the hon. Gentleman for his kind welcome. Let me make two points. First, it is true that the population of young people has increased, but the percentage—the proportion—not in education, employment or training has fallen, as I said to him. Secondly, it is also the case—this is the important point—that many fewer young people today are employed for long periods, and the periods in which they are out of education, employment or training tend to be short.
	To pick up on the point about my right hon. Friend the Prime Minister, in May 1997, more than 85,000 18 to 24-year-olds had been claiming jobseeker's allowance for more than 12 months. That fell last month and it is now fewer than 7,000. My right hon. Friend was absolutely right.

Si�n James: I thank my hon. Friend for her answer, but I ask her to make representations to the HSE on leaflet IND(G)209. I am particularly concerned about that leaflet, as it has not been updated since 1995 and it needs to include important information for young people on sunbed use. Please will she ensure that?

Anne McGuire: I thank my hon. Friend for her question, which is important as malignant melanoma of the skin is among the five most common cancers in the 15 to 24 age range, and it is estimated that skin cancer rates will treble over the next 20 to 30 years. I can give my hon. Friend the assurance that the HSE is shortly to put out for consultation a revision of its guidance on sunbeds, and that that guidance advises that all tanning salons should be staffed and calls up World Health Organisation guidelines that people under 18 years of age should avoid sunbed use.

Russell Brown: I thank my hon. Friend for that response, but many benefit recipients remain exposed to the activities of some loan companies which conduct their business along the lines of sub-prime lending. Does he agree that there is much to be gained by his Department co-operating with colleagues at the Department for Business, Enterprise and Regulatory Reform in the promotion of easy-to-access credit unions?

James Plaskitt: Yes, I agree with my hon. Friend, and he is absolutely right to point out that many people are victims of the doorstep loan sharks, who sometimes apply interest rates in excess of 1,000 per cent. without, of course, declaring that that is the case. We want to protect people from having recourse to such unaffordable credit, and the investment we are making through the growth fund is leading to a substantial expansion of the credit union movement. My hon. Friend is right that we are working with colleagues in the Department for Business, Enterprise and Regulatory Reform, which is funding hundreds of advisers who are working in local areas giving free face-to-face advice to people on managing their debt.

James Plaskitt: The credit union in Nuneaton is one of the credit unions that is receiving additional support through the growth fund investment that we are making. That investment is helping to increase substantially the scope of this country's credit union movement. I know that in some areas where growth fund money is being invested the number of people joining local credit unions has doubled, and we hope to see much more of that as we go forward with the next two or three years of growth fund investment. We are finally putting resources behind expanding what is an important sector that is working in all of our communities and assisting people on low incomes.

Anne McIntosh: Everybody would wish to support genuine lone mothers back into work when that is appropriate. However, does the Minister not appreciate the fact that the current tax and benefits system discriminates against married couples? Will he look into that at the earliest possible opportunity?

Stephen Timms: The hon. Lady is absolutely right that everybody is better off when parents are in work. We have made the changes that I have referred to for lone parents, but the point also applies in the case of couples. It is in everybody's interests for people to be in work. Where there is a question whether people are better off in work, Jobcentre Plus advisers can carry out a calculation to show the financial gains of work, and the better off in work credit will help further. I think that we can agree across the House that it is in everybody's interests for parents to be able to work.

Stephen Timms: I will certainly examine the point that my hon. Friend has raised. We want to ensure that lone parents plan for a better future for themselves and their children, and that will require lone parents moving on to more appropriate benefits when their youngest child is 12 and over from October this year, as she knows, and 10 and over and seven and over later. I shall certainly examine her point and drop her a line in response.

Mike O'Brien: We expect to pay 12 million winter fuel payments this winter. In addition, the Pension Service is currently working with the energy suppliers to target further help to 250,000 vulnerable pensioners in receipt of pension credit throughout England, Scotland, and Wales. We are also working closely with other Departments to develop a cross-governmental strategy to help further reduce fuel poverty.

James Purnell: Last November the Government announced a strategy for reducing the number of young people who are not in education, employment or training. As part of those proposals, from next April all young people who have not been in employment, education or training for at least 26 weeks by the time of their 18th birthday will be fast-tracked to the intensive support and sanctions regime of the new deal. If they fail to find work after six months, they will be referred to a specialist provider from the voluntary or private sector.
	I can announce today that we will look to contract with providers who will work with young people in this category to do substantial amounts of work-related activity, underpinned by a minimum of four weeks full-time work-related activity relevant to the individual. That is an important new initiative to connect young people to the world of work and ensure that they learn basic skills such as teamwork and work-related disciplines, including timekeeping.

Michael Penning: May I say that that was absolutely fascinating? However, on the subject of Buncefield, two years on from the explosions, the inquiry is still going on behind closed doors. Although I criticise its being done behind closed doors, I have no criticism of Lord Newton and his team. Could the Secretary of State assist the inquiry team in reaching a conclusion on whether a criminal prosecution should take place and whether compensation can be paid to my constituents who have suffered so much?

Danny Alexander: I congratulate the Secretary of State on his deserved promotion, but since he took office pronouncements on welfare reform have sent mixed messages: on one hand, they have threatened to take people's houses, and on the other, they have promoted the idea of financial incentives. When will he face up to the real barriers put up to benefit claimants by the huge complexity of the benefit system, which he has not so far addressed? Will he start by introducing plans for a single working-age benefit, which would do a lot to reduce barriers to work for many benefit claimants?

James Purnell: I am afraid that the Conservatives have just got their figures wrong on this. As has been pointed out, they have failed to reflect the fact that there was a change in the name of one of the benefits, so they have added two completely different categories. What actually happened was that, when the Conservative party came to power, 700,000 people were in that situation, and we inherited a situation where there were 2.6 million such peoplemore than treble the number. The figure has started to fall under this Government, but we want to do more.
	That is why we are introducing the employment support allowance from October this year. Instead of judging people on the basis of what they cannot do, which is the system we inherited from the hon. Gentleman's Government, we will judge people on the basis of what they can do. There will be an earlier medical assessment at 13 weeks. There will be greater support for people who will not be expected to work, but greater requirements to look for work for everyone else in that category. This is a major reform of the systemone which was not undertaken by his Government. The reason why the numbers increased was that they were happy to see them increase. We are not happy to see them increasethey are falling under usand we have now set ourselves the goal that 1 million more people will come off incapacity benefit by 2015. That is the most radical reform of the system that this country has ever seen.

Laurence Robertson: I have a number of engineering companies, particularly in the aerospace industry, in my constituency. One of the problems that they have is in attracting young people in particular to engineering; it is not seen as the kind of work that they want to do these days, but it is extremely important to those companies. Given that more and more people are staying on at universities, but that they are sometimes failing to find jobs, what can the Government do to ensure that young people who go to university take the appropriate courses that will enable them to find work and that will also satisfy the engineering companies in my constituency that struggle to find the right employees?

Stephen Timms: The hon. Gentleman raises a very important issue. Aerospace has been a very big success for the UK economy over the past few years, and a success that we want to continue. The Engineering Employers Federation said in its recent review of the state of manufacturing that there had been something of a renaissance in UK manufacturing more broadly. The hon. Gentleman is absolutely right: we need to make the most of those new opportunities in engineering to increase employment among people and to give them access to the opportunities that are becoming available. That is why the new diploma in engineering, to which reference was made earlier, is an important step and why it is also so important that we are increasing the number of apprenticeships in aerospace and elsewhere.
	I visited Nissan in Sunderland on Friday. The company is just about to add a third shift for the production of the Qashqai vehicle. It is having to recruit 800 extra people into that factory alone for that, and it thinks that another 400 jobs will be involved in the supply chain nearby. In addition to all that, the hon. Gentleman is quite right that we need to encourage young people

Alistair Darling: With permission, Mr. Speaker, I would like to make a statement on Northern Rock.
	I hope that the House will understand that it was necessary for me to issue a statement yesterday, ahead of the markets opening, so that trading in Northern Rock shares could be suspended this morning. It was also essential to allow the management of Northern Rock time to tell its employees what was happening so that the bank could open as normal this morning.
	As I said yesterday, the Government have decided to introduce legislation to take Northern Rock into a period of temporary public ownership. I took this decision after full consultation with the Bank of England and the Financial Services Authority. The draft Bill to do this has been available in the Vote Office and the House of Lords since this morning to provide as much time as possible for right hon. and hon. Members, as well as the other place, to examine the provisions of the Bill. If the House agrees, the Bill will begin its parliamentary passage tomorrow. I have also arranged for the principal Opposition spokesmen to be briefed by Treasury officials today.
	It is important for savers and depositors to be reassured that their money remains safe and secure. Northern Rock will continue to operate as a bank on a commercial basis, and it is open for business as usual today. The Government guarantee arrangements that I announced last year remain in place and will continue to do so. Borrowers will continue to make their payments in the normal way.
	I have appointed Ron Sandler as the executive chair. He is in Newcastle today and has had meetings with the company and its employees. The new board and the bank will operate at arm's length from the Government with commercial autonomy for their decisions. I will publish shortly the framework agreement that will outline how the relationship between the Government and the Northern Rock board will work.
	As I said yesterday, the board's proposals will also cover the Northern Rock Foundation, which is very important to the north-east. The board will commit to guaranteeing a minimum income of 15 million per year in 2008, 2009 and 2010. That will be paid directly by Northern Rock, as now, and would be a condition of any sale, if it were sold in that time. The new board will be asked to identify a long-term future for the foundation.
	I want to set out the reasons for the decisions that I made and to outline what the new legislation will do. Before that, let me remind the House that last September there was almost universal agreement that the Government were right to intervene to save this bank to stop its problems spreading to the wider banking system. There was also agreement that, ultimately, the long-term future of the bank must lie in the private sector. Even those who advocated nationalisation in the autumn did so on the basis that it could be only a temporary stepa stepping stoneto return the bank to the private sector when market conditions made that possible.
	Throughout last autumn, and from the start of this year, the Government wanted to test all the options and to give the shareholders and the management time to find a solution that was acceptable and that met the three principles that I set out last year: to support financial stability; to protect depositors' money; and to protect the interests of the taxpayer. I said throughout that all options, including a period of temporary public ownership, remained on the table.
	As the House will know, the Government had two private sector bids to consider. Each was tested against the option of a temporary period of public ownership to see which met our objectives and principles, including best value for the taxpayer. Both proposals involved a degree of risk for taxpayers and a very significant implicit subsidy from the Treasury, involving a payment below market rate to the Government for continuation of our guarantee arrangements and for the financing that we would put in place.
	Each proposal had its pros and cons. The Virgin proposal, for instance, would have brought in a new brand and management. However, the taxpayer would have received a share of the private sector return only if the business's value to its investors reached at least 2.7 billion. The board's proposal would have involved a similar level of subsidy, but it had other disadvantages compared with Virgin's. It would have brought in less new capital, and the business would have depended longer on Government guarantees for new retail deposits. A subsidy on the scale required would not have provided best value for the taxpayer. The private sector rather than the taxpayer would have secured the vast majority of the value created, and that would have been a poor reflection of the balance of risk borne by the two sides. By contrast, under public ownership, the taxpayer will secure the entire benefit and proceeds from the sale of the business in return for bearing the risks during this period of market uncertainty. That is why we made the decision that we did. We made the decision to protect taxpayers after having weighed up the various competing considerations. In deciding which was the best option for the taxpayer, it was clear that a temporary period of public ownership was the better option.
	I will go through the contents of the Bill in more detail on Second Reading tomorrow. We have deliberately drafted it to ensure that a bank can be acquired only in certain tightly defined circumstances and the power to do so will last for only 12 months. I have already announced a consultation that will lead to permanent legislation to deal with such situations in future. The Bill potentially applies to a range of financial institutions, but I want to make it clear that the Government have no intention at present to use the Bill to bring any institution other than Northern Rock into temporary public ownership.
	The Bill also provides for appropriate compensation to shareholders. As I explained on 21 January, those provisions are on the basis that all financial assistance provided by the Bank or the Treasury, including guarantee arrangements for depositors, had been withdrawn and that no further financial assistance, apart from ordinary market assistance from the Bank, would be provided to the deposit taker. I believe that that is fair both to shareholders and to the taxpayer. The Bill makes provision for transfer of the bank or parts of it to the private sector.
	I remind the House that following the problems that started in the United States last summer, Northern Rock was unable to raise the billions of pounds that it needed to stay in business. We were right to save the bank and to do everything we possibly could to find a private sector buyer on terms acceptable to the taxpayer. Because of current market conditions, we are now right to take over the bank on a temporary basis, because that is what is in the best interest of the taxpayer. There were choices to be made. We could have let the bank go under, but the risks to the wider financial system, for savers and for the general public were not acceptable. Having made the decision to save the bank, maintain financial stability and protect savers, we are now taking this decision to protect the taxpayer. I commend this statement to the House.

George Osborne: Never before in the long history of his office has a Chancellor had to come to Parliament to announce the nationalisation of a high street bank. For months, the Prime Minister dithered and delayed, doing everything he could to avoid the very course of action that he now recommends to Parliament. We know why. As the Chancellor acknowledged at the Dispatch Box, nationalisation means the
	slow lingering death
	of Northern Rock
	and Britain's reputation as a major financial services centre,
	with him
	cast in the role of undertaker.[ Official Report, 19 November 2007; Vol. 467, c. 968.]
	I have three sets of questions to ask that self-confessed undertaker. First, will he reaffirm that nationalisation means that the taxpayer is
	bearing all of the risk?[ Official Report, 21 January 2008; Vol. 470, c. 1210.]
	That was the phrase that he himself used last month in the House when he argued against nationalisation. Nationalisation means that the taxpayer's risk has doubled to 110 billion, or 3,500 for every family in Britain. Every family in Britain will now own the high street bank that wrote more mortgages at the top of the housing market than any other. Every time a home owner fails to meet a mortgage payment, every family in the country will bear the cost. That is what this nationalisation means. Can the Chancellor tell us about the state of the 100 billion mortgage book that he wants the taxpayer to own? How many bad loans are there? The credit rating agencies now say that the losses are rising at Northern Rock. Is that true? Before we debate the Bill tomorrow, we are entitled to a full statement of the financial position of the company that we are being asked to buy. We are entitled to see the advice from Goldman Sachs that we have all paid for.
	Secondly, will the Chancellor agree that it is totally unacceptable for Northern Rock to continue with business as usual? This is now a Government bank; it can borrow and lend more cheaply than any of its high street competitors. Indeed, today it is still offering some of the best savings deals out thereit is still offering the 125 per cent. mortgages that it wrote last year. That is politically and economically unacceptable. Nationalisation can never mean business as usual. The Chancellor said in his statement that the management would be at arm's length. Why is there nothing in the Bill to prevent political interference?
	Thirdly, will the Chancellor confirm that he is actually introducing unprecedented, sweeping, draconian powers that will let him nationalise any other bank or deposit-taking institution in Britain by ministerial fiat?  [Interruption.] The Lord Chancellor should pay attention; he keeps talking about strengthening the powers of Parliament, but he is about to give the Chancellor of the Exchequer the power to nationalise any bank in Britain without coming to Parliament. That is something that not even Michael Foot dreamed of. It will create further uncertainty in financial markets and do further damage to Britain's reputation. If the Chancellor is giving himself those sweeping powers only to get round parliamentary procedures for hybrid Bills, he should give himself them for a week or a month, not for a whole year.
	The Chancellor had opportunities to avoid the disaster of nationalisation last autumn, and he missed them. He has the opportunity now to avoid the disaster of nationalisation by opting instead for a reconstruction led by the Bank of England, and he will not take it. It would mean 55 billion less exposure for the taxpayer, and none of this farce of business as usual; it would be like the approach that the Chancellor himself recommends for future bank rescues. But instead, the Prime Minister and his Chancellor have dithered their way to disaster. Now what they call the temporary nationalisation could, in the words of Ron Sandler, last years.
	In uncertain economic times, the British people have a right to expect decisive and strong leadership from their Government. Instead, this Chancellor has given us weakness and indecision, with humiliating reversals over capital gains tax, then non-domiciles and now Northern Rock. He has taken Britain back to the 1970s and the failed policies of Labour's past. We can safely say that he will never recover his reputation for competence. He is now politically a dead man walking and if the Prime Minister could make a decision, he would move him. What matters to the rest of us is that the British economy and its reputation abroad recovers from the Chancellor's disastrous time at the Treasury. Nationalising a high street bank is not the way to begin, and we will oppose it tomorrow.

John McFall: I welcome the Chancellor's statement on the basis that it protects the interests of taxpayers, which the Treasury Select Committee identified in its report. Given the arm's length management that will operate under Ron Sandler, no doubt the Committee will want to receive regular updates from him and his colleagues to ensure for ourselves that accountability is the key here. Given the unique position of Northern Rock as a nationalised institution, does the Chancellor agree that accountability is extremely important in order that it does not distort the financial markets at any time?

Alistair Darling: First, I thank my right hon. Friend and his colleagues on the Treasury Select Committee for the very thorough investigation and piece of work that they did in relation to Northern Rock.
	Secondly, in relation to the running of the company, it is important that the management team led by Ron Sandler has the opportunity to make its decisions, first, to come up with a business plan, which we need to submit to Europe as part of the state aid approvals process, and then to be allowed to get on with the job. Yet again, I profoundly disagree with what the shadow Chancellor said. He seems to imply that it would be better for the bank to go bust rather than to allow it to trade and get through the difficulties that it presently faces. We will be in some difficulty if we go down the road of holding the management team to account for every single thing that they do. I am sure that the Select Committee will want to know about the business plan and want to discuss these things, but it is important that the management team gets to operate at arm's length from the Government and gets on with running the company, because that is the best way of ensuring that it can be restructured and refocused and can then be returned to the private sector when it is appropriate and right to do so.

Alistair Darling: I agree with a lot of what the hon. Gentleman says. He is quite right to remind the House that there have been many occasions when Governments have thought it right to intervene to take action to preserve stability or, in some cases, to preserve vital industries. He will remember what happened in the 1970s because I seem to recall that he was in the Labour party then. He is also absolutely right in his description of the Conservatives' policy. Their policy is nationalisation. It involves nationalisation, but the hon. Member for Tatton has the gall to say that he is going to oppose the Bill that will bring that about. The only way he could deliver his policyin as much as it is understandable and that it will last for the next day or sowould be to nationalise, so it seems extremely odd that he intends to oppose the legislation tomorrow.
	On the hon. Gentleman's specific questions, the FSA is responsible for regulating Northern Rock and it judges the mortgage book that Northern Rock holds to be of good quality. On the business model, as I said earlier, Ron Sandler and his team will introduce a model after they have had a chance to consider the options available to them. That will have to be endorsed by the Government, because it has to be cleared by the Commission under the normal state aid rules. Once we have taken that action, assuming that Parliament agrees to it in the next day or so, I believe that there is a good chance that we can help Northern Rock to get through this period, and that seems infinitely better than the Tory options of either bankrupting it or finding some other pretty ill-defined destination for it, which make no sense to me whatsoever.

Doug Henderson: Listening to media reports this morning, it seemed as though the Conservative party were dead set on destroying the great northern institution of Northern Rock, and were prepared to see its assassination in their bitter opposition to nationalisation. However, it now seems that we are hearing different things for different audiences. I can tell my right hon. Friend that people in the north-east, and particularly the bank's staff, will welcome the announcement of the establishment of a framework agreement. He will understand the considerable anxiety among the population at large in the north-east, particularly those staff. May I press him to undertake early publication of a business plan so that stability is brought to the business at the earliest possible date?

Stuart Bell: The Chancellor is perfectly right to refer to the sub-prime mortgage crisis in the United States and the ongoing difficulties in the financial markets. Against that background over the past five months, has he not ensured financial stability, prevented contagion, defended the interests not only of the taxpayer, but of Northern Rock's depositors and savers, and provided guarantees that have not been called upon? Given that fact, will he ensure that temporary ownership is also prudent ownership and does not fall within the time scales of our 24-hour news media?

Adam Price: It is not just the people's bank that people are concerned about; it is the people's debt. We have heard the figure of 100 billion, but what is the Chancellor's estimate of the total liability to the taxpayer, including the guarantees, the loans and any shareholder compensation? Will that amount now also include subordinated debt, which also runs to some billions? He said that the FSA regulates Northern Rock, but is he content with that situation? The FSA is required to produce a risk analysis of building societies every six months, but where was it? Did it tell the Treasury of its concerns about the massive over-reliance on the wholesale market? If it did not tell the Treasury, heads should roll at the FSA; if it did, perhaps Ministers should be considering their positions.

Alistair Darling: I have to tell the House that, if we were going to assess the Conservative party's policies on this matter, we would have to hugely increase the number of people whom we employ, simply because its policies seem to change every day.

Alistair Darling: No, that is not the position. There is provision in the Bill to allow for assistance to building societies, because that power does not exist at the moment; it seems to me prudent to include it in the provisions. The tests that have to be passed before a bank can be nationalised are quite high. There will have to be a substantial, serious threat to financial stability, or funding must have been given that has been underwritten by the Treasury, as is the case with Northern Rock. The test that will be applied to any financial institution that is getting into difficulty is simply this: does it present a systemic risk to the system as a whole? If it does, there will be a case for Bank of England intervention; if it does not, that will not be the case. The tests that we shall apply have not changed, and they will not change as a result of the legislation.

Gerald Kaufman: Has my right hon. Friend noticed that  The Daily Telegraph says today that he is doing the right thing in bringing Northern Rock into temporary public ownership, and that his action is likely to have considerable advantages for the taxpayer? Does not the view of that Tory newspaper contrast with the vacuous blather given from the Conservative Front Bench? That is the party that rushed the nationalisation of Rolls Royce through the House.

Alistair Darling: I remember the nationalisation of Rolls Royce; I was not here at the time, although I am pretty sure that my right hon. Friend was. I did indeed notice the remarks in  The Daily Telegraph, although I must concede that it took me some time to get to the bit that said I was doing the right thingit was a pleasure to read it. The problem for the Tories is that they do not actually have any coherent idea of what to do in this situation. Their position changes from day to day, and from week to week. Therefore, all that we see is cynical opportunism, because they have nothing else to offer.

Alistair Darling: Once again, half the Conservatives seem to want the bank to fail, while the other half are worried about its being too successful. I said in reply to the right hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) that whatever business plan is approved has to meet the European state aid rules, which are there to ensure that there is not unfair competition when an institution has a degree of support from a Government. It is important for Northern Rock to have the opportunity to continue to trade in order to get through this difficult periodand I am sure that it will be painful for the company. However, if we take the opposite view of removing the guarantees and stopping it from trading or offering productsI am not sure that the hon. Member for Ryedale (Mr. Greenway) was advocating thatwe might as well put Northern Rock into administration, which would result in a significant loss to taxpayers. I cannot believe that that is his position.

Rob Marris: I welcome the business statement and I also welcome the fact that the draft orders will be available tonight. When I checked with the Public Bill Office and the Table Office an hour and a half ago, the explanatory notes were not available. This is a 24-page Bill and it is quite technical, so while I congratulate the Treasury team and the draftspeople on what they have done with the draft orders, can my right hon. Friend say when the explanatory notes will be available for Members?

Harriet Harman: The House will understand that the Bill needs to be considered in this House and also in the House of Lords. We have to be sure that we do not prolong any uncertainty and that we come to a swift conclusion. Of course, I have taken into account how the Bill should be dealt with in the House. We want proper scrutiny as well as an outcome that takes place as expeditiously as possible. However, the hon. Gentleman will know that it is not unprecedented in such situations for a Bill to be dealt with in this way. I have a list of Billsit is far to long for me to read out to the Housethat the House was asked to consider in one day because of the circumstances that arose. The hon. Gentleman will be aware that that is the case. The way in which we are proceeding is necessary and it is not unprecedented.

Theresa May: On a point of order, Madam Deputy Speaker. May I seek your guidance on a point of clarification about the exchange that just took place on the tabling of amendments to the Bill? The Leader of the House did not answer the question of when it would be possible to table amendments to the Bill. Normally, amendments can be tabled only after Second Reading has been completed. Tomorrow, we will consider a business motion and then Second Reading. At what time will it be possible for hon. Members to table amendments to the Bill for consideration in Committee?

Andrew Dismore: I also wish to speak in support of new clauses 2 to 4 and amendments Nos. 3 to 18. These new clauses and amendments have been tabled in my name and that of the hon. Member for Oxford, West and Abingdon (Dr. Harris), who cannot be here because he is away on Select Committee business, on behalf of the Joint Committee on Human Rights, which I chair and of which he is a member. As hon. Members will know, we scrutinise all Government Bills for their compatibility with the Human Rights Act 1998 and the UK's international human rights obligations. We report on the most significant human rights issues, and we have now begun to publish amendments to give effect to our recommendations. Our new clauses and amendments deal with omissions from the Bill. We expect to publish another report on the Bill shortly, commenting on some of the proposals in the Bill, particularly those to do with public health.
	New clause 1 deals with the scope of the Human Rights Actin particular, the meaning of the term public authority, which has become somewhat restricted, far more so than originally intended, and is consequently an extremely important issue. My Committee has published two reports in recent years on the meaning of the term public authority in section 6 of the Human Rights Act. That section requires public authorities to act in a way that is compatible with the convention rights set out in the schedule to the Act. The definition of the term public authority includes
	any person certain of whose functions are functions of a public nature.
	What constitutes a function of a public nature is not further defined in the Human Rights Act. When the issue was discussed during the passage through Parliament of the then Human Rights Bill, it was clearly understood that that provision was intended to cover private sector providers of publicly funded servicespublic services that had been contracted out to the private sector or wholly privatised, for example.
	A series of court cases, starting with the so-called Leonard Cheshire case and culminating in the judgment by the Law Lords in the YL case in June 2007, has narrowed the scope of the Human Rights Act as originally intended, particularly in relation to care homes. The YL case concerned the eviction from a private sector care home of an elderly and frail old lady whose care was paid for by Birmingham city council. By a majority of three to two, the Law Lords ruled that the person concerned could not bring an action against the care home under the Human Rights Act, over the infringement of her rights under article 8 of the conventionthe right to respect for her private life and home. They said that her claim lay solely against the local authority that had funded her care. The 1998 Act therefore does not apply to private bodies, and the Law Lords found that that included private care homes, even for publicly funded residents.
	In our March 2007 report on this subject, we concluded that there was a strong case for a separate interpretative Act that would clarify the meaning of the phrase functions of a public nature in the Human Rights Act. The outcome of the YL judgment has only served to reinforce our concerns and emphasise the need for the Government to act urgently, to reinstate the originally intended scope of the Human Rights Act. That is especially the case given that the Government's strategy of seeking a positive judgment in a higher court has manifestly failed to deliver the desired outcome.
	Since the YL judgment, Ministers have expressed agreement in principle with our position that the current state of the law is unsatisfactory, especially for elderly care home residents, who are an especially vulnerable group that the Human Rights Act should protect. For example, the Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw), said in Committee that the Government were
	committed to amending the Human Rights Act to ensure that all independent providers of publicly funded care homes are covered by it. [ Official Report, Health and Social Care Public Bill Committee, 15 January 2008; c. 200.]
	I brought forward a private Member's Bill in the last Session that would have clarified the scope of the Human Rights Act. During its Second Reading debate in June 2007, the then Minister, who is now the Solicitor-General, said that the Government were committed to taking action that year. Unfortunately, they have not moved quickly to clarify the scope of the Human Rights Act. Instead, they propose to bring forward a consultation on the issue as part of the Green Paper on a possible British Bill of Rights and responsibilities. We have been told that the Green Paper will be published in the first half of this year, so it seems pretty clear that concrete proposals will not emerge from the consultation exercise before the next general electionno matter when that happens to be.

Andrew Dismore: Yes, that is a consequence of the YL case. During a Liaison Committee sitting, I put that point to the former Prime Minister. He said that such a situation would be severely anomalous, and that people with publicly funded places in the private sector ought to be protected by the Act, as not protecting them would militate against contracting out and privatisation as ways to deliver public services.
	Our other concern about the broad amendment moved by my hon. Friend the Member for Luton, North to encompass self-funders in the health and social care sector is that it would do little to fix the problem for other vulnerable groups such as those that I have described, and might support the false impression that nothing further needs to be done to rectify the anomaly. New clause 1 proposes restoring, for the health and social care sector pure and simple, the Human Rights Act's original intention, which is that the Act should cover private-sector providers of publicly funded services, under arrangements made pursuant to statutory powers. I hope that the Minister will consider carefully the new clause and its purpose. I hope that he will accept it, but if he is unwilling to do so, I urge him to tell the House today that he will undertake to introduce his own amendments to achieve the same effect in the other place.
	The other new clauses and amendments that I have tabled are intended to implement the recommendations in our report, The Human Rights of Older People in Healthcare, published last summer. We described how the use of human rights can be a powerful lever to improve the quality of services, as well as guaranteeing in their delivery basic concepts such as dignity and respect for the elderly in hospitals and care homes. As I said, the report gave graphic evidence of abuse and showed that many homes are not compliant with existing regulations. We said that the care standards regulations should require care homes to respect residents' human rights. The regulations governing the operation of health and social care providers, which deal with matters including staff training and the handling of complaints, require that the health, safety and welfare of service users be secured. We recommended that users' human rights should also be central to the operation of health and social care providers, and amendments Nos. 3 and 4 are designed to achieve that.
	We recommended that the new Care Quality Commission should adopt a human rights framework to underpin and inform its work and make it more effective in fulfilling its statutory duties. We were disappointed that the Government's reply to our report did not address that issue adequately. New clause 2 and amendments Nos. 5 to 7 would ensure that the protection and promotion of human rights are central to the new commission's performance of its functions. If the Minister cannot accept the amendments, I should be interested to hear why he thinks our proposals unnecessary. Help the Aged has said clearly that its main concern is the YL loophole. Notwithstanding that, it believes that the CQC can and should promote and protect human rights through its own work, saying:
	It is vital that the CQC takes a human rights-based approach,
	and that
	this vital remit should be explicit in the legislation...CQC's work on human rights should go far beyond that of any normal public body. Respect for and promotion of human rights should be fundamental.
	Help the Aged welcomes the amendments that I have tabled.
	The outgoing Commission for Social Care Inspection also supports our approach, saying:
	The new commission should place the rights of the people who use services and their carers at the heart of its work and they should have clear rights of access to it.
	Our report on the Bill published in February clearly recommended that the
	merged inspectorate...should adopt a human rights framework,
	and we were disappointed by the Government's response, which said:
	The Department of Health will not be specifying the precise work programme of the new regulator, but will expect compliance...to form an important element of its work.
	There are three problems with that. First, putting the human rights of health and social care users at the heart of the commission's work is not equivalent to specifying the precise work programme; it is more fundamental. Secondly, compliance with the Human Rights Act is a legal requirement, not simply something that the Government can expect to happen. Our concern is to ensure that human rights influence the work of the new commission across the board and are not seen simply as a tick-box compliance exercise.
	Finally, our report concluded that the Healthcare Commission should not view the 1998 Act as one of the large number of sets of regulations to which it is subject. We said that it should instead regard the framework created by the Act as overarching and fundamental to all its work. We regret that the Department of Health failed to address that point. It simply restated the current positionthat the Act is seen as just another statute applicable to public bodies and demanding compliance, rather than as the culture change that we recommended in last summer's report on the human rights of the elderly.
	We have seen the point come through strongly in the evidence that we have been taking on access to services for adults with learning disabilitiesan issue on which we hope to report in a few weeks' time. I am pleased that CSCI fully agrees with our conclusions. I hope that the Minister will reflect on that and agree with us that it is essential that the issue becomes an overarching part of the commission's work.
	Amendments Nos. 8 and 11 deal with the functions of the new commission. Amendment No.8 would require it to take into account the
	need to improve the range and quality of information provided by health care and social care services to users of those services about their rights.
	That is crucial. Without clear and accessible information about how human rights apply in hospitals and care homes, service users will not be in a position to challenge how they are treated or to know how to seek redress. We have been particularly concerned about older people and people with learning disabilities, but accessible information is essential to secure the protection of the human rights of us all.
	We have all seen the signs in public buildings saying that staff are entitled to be treated with dignity and respect. However, we do not often see signs that say that service users, patients or relatives are entitled to be treated with dignity and respect by staff. That, however, should be part of the information process. A lot of hospitals, including those in my constituency, give leaflets to people as they arrive about how they can expect to be treated, but not about their rights in respect of how they will be treated. Such information is essential if people are to be able to enforce those rights.
	We also recommended that in undertaking its work, the new commission should take into account the provision of advocacy services. Amendment No. 11 deals with that issue. The Government share our view of the importance of advocacy for older people in health care as well as in other contexts. The important role that advocacy can play in supporting vulnerable people in health and social care will be reinforced by a statutory reference to advocacy in the Bill.
	New clause 4 relates to health and social care standards. The Bill does not require the Secretary of State to publish care standards or indicate what the content of those standards might be. We recommended that the CQC should apply a single set of standards for health and social care in relation to issues engaging the human rights of service users. New clause 4 is our suggestion of what a human rights standard might look like. It includes requirements in respect of: staff training on respecting the rights of service users; the publication of complaints procedures; a duty on people to report any failure to respect human rights that they see; discharge arrangements; and the publicising of the standards that apply. If the Minister sees a problem with those requirements, I would be grateful if he told me what it is.
	Finally, we recommended that a basic understanding of how the 1998 Act requires the protection of basic principles such as dignity, fairness, respect and equality should be included in the qualifications, accreditation and re-licensing of health professionals; amendments Nos. 14 to 18 seek to achieve that.
	Achieving effective human rights protection requires a combination of different measures operating in different ways to make human rights considerations more central to the decision-making processes of health and social care providers and the new regulator. I urge the Government to accept in principle that the Bill should be amended to reapply the 1998 Act to publicly funded residents of private sector care homes. I also urge him to consider seriously our other amendments, all of which are intended to protect the rights of extremely vulnerable people in the health and social care sectors.

Joan Walley: I welcome the opportunity to speak briefly on this group of amendments and new clauses and I say to my hon. Friend the Minister that I support the spirit of the proposed changes.
	I would like to consider briefly aspects that relate to the trend of contracting out and privatisation of health and social care services. At a time when an increasing number of public services are provided by the private sector, it is essential that we get the Bill right. I am conscious that this is not the final opportunity that we will have to debate the matter, and I am speaking now to implore my hon. Friend the Minister to take into account my specific concerns on issues of detail, which relate specifically to subsection (2) of new clause 4. If the spirit of that provision were adopted by the Government, the Secretary of State would
	prepare and publish statements of standards in relation to the provision of health care and social care dealing with matters other than those listed in subsection (1).
	I would like to consider that measure in relation to the provision of non-emergency ambulance services. My concern stems from a particular state of affairs that has existed in north Staffordshire and Stoke-on-Trent for a long period of time, where patient transport services are contracted out. I seek clarification from the Minister during this debate, and during the course of the progress of this legislation, on the details concerning transport.
	I have examined the Bill, but I did not have the privilege of serving on the Committee that considered it. Clause 4(3) refers to transport services for elderly and disabled people as being
	connected with the provision of health...care.
	Therefore, I am assuming that that will be a regulated activity that has to be registered with the commission. The Bill does not make explicitperhaps the Minister could be helpful by clarifying this so that it will become apparent through subsequent readings of  Hansardwhether that will include all the associated facilities for providing such a service, such as staff accommodation and depots.
	As far as new clause 4 is concerned, I am looking at clauses 11, 12, which deals with regulations about registration, and 16, which deals with the regulation of regulated activities, and although there is a need to register, I can see nothing elsewhere in those clauses that would require the commission to consult other agencies, such as the local environmental health authority, as to whether the application for registration should be granted or refused. Perhaps I should say at this point that I speak as a vice-president of the Chartered Institute of Environmental Health. I would like the Minister to set out the role that he anticipates for local authorities with regard to information they might have on whether private providers of some regulated services are suitable. For example, I would like to know what account the commission can take of issues such as food safety, hygiene or health and safety matters. If the Minister considered clause 4(3)(b) in detail and perhaps providing for associated facilities after transport, that might be a way in which to tackle some of my concerns and those of others about the matter.
	If the Minister could clarify the issue, it would give me some sense of security that depots and staff rooms associated with private ambulance services would be included in the regulated activity and taken into account in the registration process so that we could deal with unhygienic facilities, if necessary. Much legislation relates to health and safety at work and there is a procedure for considering the health and safety at work aspects of the measure. However, when we deal with the most vulnerable people in our constituencies, it is essential that we have all the necessary support. I implore the Minister to give some comfort about section 6 of the Human Rights Act and facilities associated with the private transport provision of non-emergency ambulance services.

Kelvin Hopkins: I am pleased to support the amendments, which my hon. Friend the Member for Hendon (Mr. Dismore) tabled so competently and ably. Indeed, they reflect amendments that I tabled in Committee, although I tried to go slightly further than my hon. Friend in that they would have covered all residents of private care homes.
	Of course, I understand my hon. Friend the Minister's concern about the difficulty of covering self-funders because the Human Rights Act specifically covers relations between the individual and the state, and self-funders are, by definition, private residents paying a private concern to care for themthe state is not directly involved. However, I believe that we should find a way to ensure that all residents of care homes are covered by the Human Rights Act. At the moment, if one is in a care home that is privatised, or moved from a public to a private care home, one is removed from coverage of the Human Rights Act, and that is unacceptable. Even if the Government tabled amendments along the lines suggested by my hon. Friend the Member for Hendon, the self-funders would still not be covered. I have a possible solution, which I will urge on the Minister later, but I will not spring that surprise on him just yet.
	The problems arise from two fundamental factors, about which I was not happy when they occurred. The first is the privatisation of care homes. If they had stayed in the public sector and all care homes were in the public sector, there would not be a problem. The second is means-testing funding. If all funding were public, without means-testing, there would not be a problem. I urge the Government to reconsider the recommendations of the royal commission on long term care for the elderly that all care home residents should be publicly funded out of taxationprogressive taxation at that. There would be no problem with coverage by the Human Rights Act if the Government ensured that all residents of care homes were publicly funded. When the royal commission produced its recommendations, it estimated the cost to the Exchequer at 1 billion a year. That is not much money in the great scheme of thingsit is the equivalent of one third of a penny on the standard rate. I have spoken to many people, in meetings and privately, and asked whether anyone would object to the equivalent of a third of a penny extra taxation to pay for long-term care for everyone, including us. Many of us, because we will live longer and are much healthier than we were, will probably finish up in care towards the end of our lives. Indeed, some people might even choose to enter long-term residential care, which should also be an option, rather than having to enter it because of ill health or infirmity. If we could all be assured that, whatever happened, we would be guaranteed long-term care at the end of our lives that was properly funded by the state, we would all be greatly relieved. Indeed, I have heard no one object to that proposition in all my conversations.
	The other issue is the privatisation of care homes. Personally, I was deeply opposed to the privatisation of care homes and opposed the effective privatisation of care in my constituency, encountering some difficulties with the local authority at the time. Nevertheless, the changes went ahead, under pressure from the Government and through the use of legislative and financial means to press the authority to move care into the private sector. In effect, that is how things happenedthere are still some public care homes, but as the hon. Member for Romsey (Sandra Gidley), speaking for the Liberal Democrats, pointed out, 90 per cent. of care is now in the voluntary and private sectors. That is a matter of concern.
	I believe profoundly in the public service ethosthe idea that when people work in care, they do so not for profit, but to care for their fellow human beings, out of a commitment to their interests. If care is in the public sector, that is indeed what happens. One of the care homes in my constituency that closed down was in the middle of a large community from which people went into residential care. The home was staffed by people from that community who were long-term workers there and was democratically accountable to the local authority. That was the ideal situation, yet the home was closed and the care moved into the private sector.
	I know that we are not talking about bringing all care back into the public sector at this stage, although there is a mood of nationalisation abroad today that I welcome very much. In the longer term, I hope that the Government will look to public ownership once again and make long-term care part of the overall health provision envisaged by everyone from Nye Bevan onwards, based on the principle of universality so well expressed by Beveridge, Bevan and many other socialists of that time, but perhaps put most brilliantly by Professor Richard Titmuss, who influenced me in my youth in setting out the case for universal provision.
	I have made my point. I hope that the Government will consider the possibility of providing free long-term care, which would overcome the problem, and, in the longer term, bringing all care back into the public health service.

Stephen O'Brien: It is always a pleasure to follow the hon. Member for Luton, North (Kelvin Hopkins). Nobody can doubt the sincerity and consistency with which he has presented his arguments both on the Bill and over many years, encompassing human rights and his views on the nature of ownership and delivery. I salute him for the consistency of his arguments.
	I do not intend to take up too much of the House's time. I pay tribute to the work of the hon. Member for Hendon (Mr. Dismore) and the Joint Committee on Human Rights, both in championing the rights of those in care generally and in keeping the Government's feet to the fire on the issue. The Public Bill Committee drew on the JCHR's work, particularly its 18th report of the previous Session entitled The Human Rights of Older People in Healthcare, HC 378. It is important to note that although the Committee was most exercised by the eviction of individuals from care homes, the Government are presiding over a wide range of human rights failings in our health and social care sectors.
	The Joint Committee report noted that
	many witnesses, including the inspectorates, providers and organisations supporting older people, expressed concern about continuing poor treatment of older people in healthcare.
	The report charted failings under articles 2, 3, 8 and 14 of the European convention on human rights in respect of, among other things: malnutrition and dehydration, which we shall expand on in the next group of amendments; inadequate assessment of a person's needs; abuse, neglect and bullying; lack of privacy in mixed-sex wards, which, as it happens, relates to another of the Government's broken commitments; a lack of dignity, especially for personal care needs; too hasty discharges from hospital; fear of making complaints, an issued that unfortunately has not been selected for debate on Report, despite our best attempts; and age, disability and racial discrimination.
	On the basis that it is appropriate to the debate, I should like the House to note the importance of the fear of making complaints in relation to the legislation that we are debating today. This is a cross-party concern. It was raised in Committee by us and by the spokespersons for the Liberal Democrats, as well as by the hon. Member for Luton, North, who said:
	A number of my hon. Friends, not necessarily members of the Committee, are concerned about changes in patient representation and procedures for patients making complaints in recent years. [Official Report, Health and Social Care Public Bill Committee, 17 January 2008; c. 346.]
	The hon. Member for Tamworth (Mr. Jenkins), who I see in his place today, also sought to hold the Government to account for their shortcomings in this area. Furthermore, the hon. Members for Oxford, West and Abingdon (Dr. Harris) and for Hendon are seeking clarification on this issue.
	The remaining unanswered questions on complaints centre on three issues. The first involves resourcing the ombudsman, who is facing an elevenfold increase in work load, yet none of the costs of that increase have been reflected in the impact assessments for the Bill. The second involves monitoring trends. With the Healthcare Commission losing its complaints function, how can we be sure that the early warning signals will be picked up by the regulator? I dare say that we all remember the tremendous work of the community health councils, which were able to use the collective wisdom of all that they had been able to achieve through their inspections and access to hospitals through programmes such as Bedwatch. That is something that we discussed at length when the Government announced that they were axing the community health councils but then had to postpone their abolition and give them a stay of execution for a year. Those functions now appear to be at risk again. I hope that the Minister will address that point specifically.
	The third issue involves putting in place a complaints system for privately funded social care. That has just been referred to by the hon. Member for Luton, North. The Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), has said in Westminster Hall that
	it is unacceptable that self-funders should not have the protection that other residents have.[ Official Report, Westminster Hall, 11 December 2007; Vol. 469, c. 52WH.]
	He also told the File on Four programme in September that he would be achieving his aim through this piece of legislation. That is all on record. That is a promise, however, that the Government now appear to have reneged on. I hope that the Minister will take note that his colleague has put that intention on the record, and I hope that the Minister has now been persuaded that this is the moment to look at this matter.
	In its submission to the Committee, the Commission for Social Care Inspection said that the new regulator should take a strong rights based approach. In support of that, the Joint Committee said that the Care Quality Commission should adopt a
	human rights framework with the intention that the framework informs all of the inspectorate's work and so makes it more effective in fulfilling its statutory duties.
	The Mental Health Act Commission, which was rightly commended by the Joint Committee for its human rights approach, was particularly concerned in its oral evidence to the Committee that the human rights focus would be lost in the merger. The Government have as yet failed to guarantee that that will not happen. The Commission has called for an overarching principle of equality and human rights, focusing at all times on the civil, legal and human rights of patients.
	In Committee, the Minister confirmed that the frequency of visitsa vital pointwould be
	a matter entirely for the new commission. [Official Report, Health and Social Care Public Bill Committee, 17 January 2008; c. 323.]
	The MHAC, however, wants visits to continue with their current six-month regularity. The choice will be truly free only if the Commission is properly resourced to do what it deems important, but the Minister has not as yet given such a guarantee. I hope that we shall be thrilled today by his contribution in that regard.
	It is disappointing that we have to have these discussions on amendments to a Bill on Report. We looked at these matters extensively in Committee, as the hon. Member for Luton, North has mentioned. He was supported in Committee by the hon. Member for Tamworth. They both raised a number of these issues, but it was felt by the Minister that campaigners on this issue would be pleased to hear his commitment that the Government were
	committed to ensuring that independent sector care homes are covered by the Human Rights Act. [Official Report, Health and Social Care Public Bill Committee, 10 January 2008; c. 135.]
	He reiterated the Government's line that that would be achieved in the Bill of Rights, but if he has committed to that, we question why he is not prepared to pass the amendments now.
	Clearly, a cart and horse situation has developed in the Government's mindthat the Bill of Rights is necessary for proper scrutiny in order to arrive at what would be relevant to the application of such human rights to private sector care homes within a Bill of Rights framework. It seems to us that the right place for a thorough going over of that was in Committee, but that was rejected during the course of our deliberations. It is in Committee, Madam Deputy Speaker, that it is appropriate to go through really intense and detailed scrutiny of these provisions, which provide complex material to interweave and interleave into existing legislation. Having an appropriate debate on these amendments now depended on having a proper Committee stage as a matter of principle. In the absence of any such debate and of the bringing forward of the Bill of Rights in advance, our present debate becomes difficult and it is not easy to form a clear opinion of how the provisions will work.
	I notice that a letter in  The Guardian today was signed by 33 different national voluntary sector providers of social care services to disabled people and many others, including all in receipt of social care. They state that the Health and Social Care Bill really must put users at the heart of regulation and argue for the rights-based approach, which was very much the evidence revealed by Dame Denise Platt, the head of the Commission for Social Care Inspection, during Committee hearings.
	If the new clauses and amendments are pressed to a Division, it would be difficult for us to signal our support, but at the same time we do not intend to vote against them either. We want to register our main point that the Bill of Rights that the Government have prayed in aid absolutely needs to be brought forward fast; otherwise, the Government's commitments will be revealed as hollow. Clearly, there is a major demand to involve human rights principles, not least those articulated by the Joint Committee, but in the absence of discussion of the Bill of Rights, we are in grave danger of trying to legislate for the cart before the horse has been debated. On that basis, our position is clear.

Ben Bradshaw: As has already been said, this group of amendments deals with a number of matters raised in the legislative scrutiny report of the Joint Committee on Human Rights, which was published earlier this month. It has provided a very helpful human rights perspective to the Bill and I would like to take this opportunity to pay tribute to the Committee's diligent and important work under the chairmanship of my hon. Friend the Member for Hendon (Mr. Dismore). Indeed, I pay tribute to all hon. Members who contributed on the issue of human rights as the Bill went through Committee.
	I hope to offer some words of comfort to my hon. Friend and to them, but I also need to say from the outset that we do not believe that most of the amendments in the group are necessary. I shall come on to explain why in a few moments. We agree with the principle behind the Joint Committee's proposed amendments, but we do not see the need to inscribe everything in primary legislation. I understand that proposing a large number of amendments in this way represents a new approach for the Joint Committee, but in this instance I am not sure that it is the most effective way to proceed. Where the Government are giving undertakings or are already pursuing a particular policy, I hope that the Committee will accept those undertakings rather than pursue the course of specifying every last detail directly in the legislation.
	New clause 1 is designed to apply the Human Rights Act 1998 to all public and all independent providers of health and adult social care registered with the new Care Quality Commission if the care is publicly funded either wholly or in part and is pursuant to statutory powers. We heard a great deal in the evidence presented to the Committee and in the Committee's own deliberations about the case for bringing private and voluntary sector health and social care providers within the scope of the Human Rights Act 1998. I said, and I repeat, that I am sympathetic to the intention of dealing with publicly funded care, be it health or adult social care, that is behind the new clause. I thank my hon. Friend and his Committee for setting out the issues so clearly. As I hope I made clear in Committee in response to a number of proposed amendments, including those tabled by my hon. Friend the Member for Luton, North (Kelvin Hopkins), the Government are firmly committed to amending the Human Rights Act to ensure that all publicly arranged care provided by the independent sector is covered by it. We have agreed with the Ministry of Justice that it would be appropriate to use the Health and Social Care Bill to strengthen regulatory powers to ensure that the Care Quality Commission can enforce regulatory requirements in line with the spirit of the European convention on human rights.
	However, as I indicated, we have difficulties with new clause 1 as drafted. For example, it links the coverage of the Human Rights Act to regulated activity, as defined in clause 4, which would be registered with the Care Quality Commission. That merely provides for regulations to determine what is a regulated activity. Therefore, the scope of the Human Rights Act could be altered by secondary legislation. I am sure that that is not the intention of my hon. Friend the Member for Hendon. I suspect that the relevant Committee in another place would consider it an inappropriate delegation of powers for an Act as important as the Human Rights Act. Moreover, we are also not sure what would or would not be covered by the test within the new clause of care provided
	wholly or partly at public expense.
	Would that cover all residents in a care home where one out of 50 was funded by a local authority? Would it apply to everyone receiving care provided by a charity that received a very small annual grant?
	However, as I said, I am sympathetic to the intention behind the amendment and the concerns expressed by evidence givers and by members of the Public Bill Committee and the JCHR. I undertake to consider the issue of publicly arranged health and adult social care and the Human Rights Act in the context of this Bill, with a view to the Government reporting back on that important issue during its passage in the other place. I hope that that offers some reassurance to my hon. Friend that the Government are continuing to consider the issue. In the light of that, I hope that he agrees to withdraw the motion.
	Amendments Nos. 3 and 4 would place a duty on the Secretary of State to ensure that regulations under clause 16 include provision intended to secure the rights of those receiving services in addition to their health, safety and welfare. We must be careful not to create an expectation that the new Care Quality Commission will be a quasi-judicial or ombudsman-type body, as the amendments would do. Regulations under clause 16 will set out specific requirements that will be in line with the spirit of the European convention on human rights, but are relevant to the provision of health and social care services. It will be by enforcing those specific requirements on health and social care provision that the commission will support the promotion of human rights.
	New clause 2 and amendments Nos. 5, 6 and 7 would require the protection and promotion of human rights to be central to the work of the commission. We had quite a lot of discussion about that in Committee, not least in response to the amendment tabled by my hon. Friend the Member for Luton, North. I confirmed that as a public body, the commission will of course be subject to the Human Rights Act and will have to carry out its functions in ways that are compatible with it. In carrying out its work in checking that providers comply with the registration requirements, the commission will be able to ensure that providers follow the spirit of the European convention on human rights.
	We are keen to get the registration requirements right. Rather than this being a tick-box exercise, to quote my hon. Friend the Member for Hendon, the commission's work in ensuring compliance will be a real driver to help to achieve the wholesale cultural change that the JCHR's report seeks. I also encourage all those with an interest in the safety and quality of health and adult social care services to participate in the forthcoming consultation on those registration requirements. That is an open invitation to him and his Committee to do so.
	Amendment No. 8 would require the commission to perform its functions in a way that encourages health and social care services to improve the information that they provide to patients and service users about their rights. We agree that it is important that people have information on their rights and entitlements so that they can make informed decisions about their care and treatment, but the amendment is not necessary to achieve that. The Government have already distributed guidance and a toolkit on human rights and health care to the NHS, and that is available to the public. The Human Rights Act makes it unlawful for the Care Quality Commission, any NHS body or local authority, as public authorities, to act in a way that is incompatible with the convention right. It is therefore for the courts to ensure that they comply. Of course, other bodies, such as the Equality and Human Rights Commission, have a leading role in that.
	Amendment No 11 would require the commission to have specific regard to whether adequate advocacy services are available when carrying out its functions. The Government recognise the importance of good advocacy services. Section 12 of the Health and Social Care Act 2001 gives the Secretary of State for Health a duty to arrange the provision of independent advocacy services for those who make complaints about the NHS, and we established the Independent Complaints Advocacy Service to support patients and members of the public wishing to complain about their NHS care or treatment. In the context of social care, we intend to provide equal access to advocacy alongside the new complaints arrangements. We are still examining the details of how that can best be achieved.
	While the commission will encourage the provision of good advocacy services through its review functions and by monitoring the adequacy of complaints processes operated by service providers, we do not consider that that should be central to its role. It would therefore be inappropriate for us to include it in the list of the matters to which it must have regard as a matter of course when carrying out its functions.
	New clause 4 is linked to clause 41, which enables the Secretary of State to publish statements of standards relating to health care provided and commissioned by primary care trusts. The standards will provide a practical set of benchmarks for different services. The new clause sets out a number of topics to be covered by standards under clause 41, relating to the rights of patients and service users. We intend to hold wide-ranging discussions and full consultation with patients and clinicians on the details of the standards, because we want to ensure that they deliver real improvements in care. We feel that it would be inappropriate to set out the details in the Bill in advance of that consultation; indeed, I am not convinced that such standards should be in primary legislation at all, as it will be necessary to refine them frequently.
	My hon. Friend the Member for Stoke-on-Trent, North (Joan Walley) expressed concern about publicly commissioned services provided by private non-urgent ambulance services. I invite her to make the case that she has made today during the consultation on the registration requirements, but I can reassure her that any publicly provided health or social care service will fall within the scope of the Bill, in terms of both human rights and registration requirements.

Ben Bradshaw: I am about to deal with the amendments Nos. 14 to 18, which refer to professional qualifications and training. I hope that this will reassure my hon. Friend. The amendments are intended to implement the recommendation of the JCHR about professional regulation, which suggested that
	basic principles such as dignity, fairness, respect and equality be included in qualifications, accreditation and re-licensing for health professionals.
	We do not consider the amendments to be either necessary or appropriate to achieve the objective that I think we all share. They seek to impose various duties on the Council for Healthcare Regulatory Excellence, the Office of the Health Professions Adjudicator and the General Social Care Council. Each of those bodies is a public authority, and as such they must already carry out their functions in a manner that is compatible with the European convention on human rights. We therefore see no need to impose specific duties on them, and do not consider that any benefit would be gained from our doing so.
	I trust that my assurance that the Government will examine the issue of publicly arranged health and social care provision and the Human Rights Act again in the context of the Bill will enable my hon. Friend the Member for Hendon to withdraw new clause 1, and I hope that I have persuaded him that his other amendments are not necessary either.

Kelvin Hopkins: Just to clarify, I understand that the Government are looking at ways to proceed to a situation in which publicly funded residents in private care homes would be covered if there was no means-testing, so that everyone is publicly funded and everyone, by definition, is covered.

Stephen O'Brien: Amendment No. 105 is intended to establish regulations to deal with malnutrition. It is drafted in the same terms as clause 16(5), which is on health care-acquired infectionsor health care-associated infections, depending on which of the Government's definitions one chooses to take. New clause 15 would provide for a code of practice on malnutrition and is drafted in the same terms as clause 17, which provides for a code of practice relating to health care-acquired infections.
	The context of the new clause and amendment is necessarily fixed within the area of health care-acquired infection. The Government have put in the Bill the need for regulations about health care-associated infections, as they call them on this occasion, notably methicillin-resistant Staphylococcus aureus and clostridium difficile, and a code of practice on preventing them. While that is laudable, I fear that it will do little to dent the Government's ongoing failure on health care-associated infections unless proper infection control measures are put in place in the code.
	Although health care-associated infections are falling, the rate is still way off track to meet the Government's 2004 target of halving MRSA rates by March 2008. The Secretary of State for Health has contradicted the Prime Minister's promise of screening for C. difficile; bed occupancy is up; deep cleaning is a gimmick with no new money attached; there is no decent search-and-destroy strategy; and Government promises on isolation wards are still being broken. I am sure, moreover, that the House was pretty disgusted by the Health Secretary's posturing promise that he would prevent a payout to the chief executive of Maidstone and Tunbridge Wells NHS Trust, considering that, on 24 Januaryjust a few days agowe discovered not only that the Secretary of State never had the power to do that, but that the chief executive received 75,000 of taxpayers' money for her failure. That is the context in which malnutrition is so important.
	As we know, according to the Government's own figures in Clean, safe care: reducing infections and saving lives, published on 8 January, MRSA affected about 6,000 people in 2006-07 and C. difficile about 56,000. By contrast, in 2006-07 no fewer than 139,127 patients were discharged from hospital in a state of malnourishment. The issue is not just about malnourishment; it is also a human rightswe have just discussed human rightsissue. The Joint Committee on Human Rights, in its recent report, The Human Rights of Older People in Healthcare, noted that malnutrition and dehydration in care settings breached articles 2, 3 and 8 of the European convention on human rights. Figures cited in the Department of Health's own nutrition action plan show that the cost of under-nutrition is estimated at 7.3 billion a year, and a recent  British Medical Journal study reported that about 20 per cent. of patients in hospitalone in fiveare malnourished.
	Despite those figures, which reaffirm those provided through BAPEN's screening weekI assume that everybody in the Chamber knows that BAPEN is the British Association for Parenteral and Enteral Nutritionan initiative that the Minister claimed to support, the Department chose to rubbish them as
	hopelessly out of date or misinterpreted.
	Furthermore, the Government's own figures, provided to me through written parliamentary answers, show that the number of undernourished patients being discharged from hospital has risen by 84 per cent. since 1997. There is little evidence that the Government have either the will or the conviction to tackle the problem. Since the new year, they have failed to take the opportunities afforded by the publication of vital signs indicators for primary care trusts, of responses to the payment by results consultation, and of the Bill to demonstrate their intention to do so. Of the 83 vital signs targets, none relates to malnutrition. It has been pointed out to the Department that the lack of recognition of support services, such as those on nutrition, in PBR acts as a barrier to the commissioning of effective care pathways.
	Most damning was the voting down in Committee of an amendment that would have put the importance of tackling under-nutrition on the same statutory footing as tackling hospital-acquired infections. Clearly, therefore, the Government see under-nutrition as a peripheral rather than central issue in respect of both health and social care and human rights. The new clause and amendment give the House an opportunity to make a genuine addition and improvement.
	Given the Government's repeated refusal to make use of opportunities to tackle under-nutrition, such as in the NHS's operational plans and the system of PBR, my view and that of my colleagues is that we simply cannot accept the Minister's feeble assurancefeeble is a strong word, but it is correct in this contextto the Committee that he hoped that malnutrition would be included in the core registration requirements examined by the new Care Quality Commission. He said no more than that he hoped that that would happen. That seems a wholly insufficient and inadequate response to what is patently a major issue, given evidence that was based wholly on the Government's own information and statistics, and which was published in parliamentary answers. Unless we hear from the Minister an important and new voice on the matter, it will be important for us to register our concern. We shall want to pursue the matter at this stage and certainly as the Bill proceeds to another place. When it does, I hope that this time the Government will support such amendments.

Sandra Gidley: The hon. Gentleman is right. The figures are set against an average decrease in the length of stay in hospital, so one wonders what is going on.
	In 2005, BAPEN published an economic analysis of the cost of disease-related malnutrition in the UK. The total cost was estimated to be 7.3 billion, with approximately 3.8 billion incurred in hospital and 2.8 billion in long-term facilities. I would have assumed that the Government would be keen to address that avoidable cost by putting in place some simple measures. We have all seen the programmes with undercover filming in geriatric wards and nursing homes, in which people are not helped to eat or given inappropriate food. Tackling the problem, and ensuring that there is a clear code of behaviour, would also address some of the human rights aspects of the issue. As the hon. Gentleman rightly pointed out, this is a human rights issue, because many elderly people are not getting the care and attention they deserve, however many dignity strategies the Government introduce.
	The conclusion of the article to which I was referring states:
	In the majority of inpatients, however, the most important single factor leading to malnutrition is probably loss of appetite and failure of intake.
	If someone is unable to eat for any reason, there are things that can be done to minimise the results. There is little detail behind the amendments, but they are well intentioned. I hope that they will find some favour with the Government, because the problem is real and avoidable. There are no targets to address it and it is too often overlooked.

Ben Bradshaw: We enjoyed a long and detailed debate on this issue in Committee. As I said then, I have a great deal of sympathy with the motives behind the amendments, but there are good reasons why they are unnecessary. As most hon. Members have recognised, we are making significant progress. We have been working closely with the Food Standards Agency to improve the nutritional quality of hospital meals. We have launched the better hospital food programme, which is having an impact. The patient environment action team assessments show that there has been an increase from 17 per cent. of food being described as good in 2002 to 44 per cent. being rated excellent in 2006-07.
	We also recognise that older people in hospital are particularly vulnerable to malnutrition. To identify and deal with that risk, we have introduced protected meal times. We are putting particular emphasis on the screening that has been advocated by a number of hon. Members in this afternoon's debate. Those two areas of work are being pursued by the National Patient Safety Agency.
	The Royal College of Nursing has recently signalled its commitment to addressing the issue and has launched its nutrition now campaign, which aims to help all nurses at all levels to improve the nutrition and hydration of patients. The Nursing and Midwifery Council, the regulatory body for nurses, has identified nutrition as one of the core skill areas to be singled out for special assessment of competence before nurses are admitted to the register, a move that we warmly welcome.
	As I mentioned in Committee, last October the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), launched a nutrition action plan to build further on that work. The plan is being developed with leading stakeholders. Indeed, Opposition Members referred to the Age Concern report, Hungry to be Heard, and they will be pleased to learn that Gordon Lishman, the director of Age Concern who is responsible for pioneering work in the field of nutrition, has agreed to chair the national action plan delivery board.
	I also described in Committee the detailed standards in nutrition that apply to the NHS under the standards for better health and the national minimum standards that apply for registered health and adult social care providers. They are core standard 15a, which states:
	Where food is provided, health care organisations have systems in place to ensure that...patients are provided with a choice and that it is prepared safely and provides a balanced diet.
	Core standard 15b states the need that
	patients' individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day.
	For assessment against core standard 15, the Healthcare Commission will use the criteria, which were signed off by the Secretary of State for Health in 2007-08, that patients should be offered a choice of food in line with the requirements of a balanced diet, reflecting the needs, preferences and rights, including faith and cultural needs, of the service user population.
	I also went on to describe how the Healthcare Commission's national in-patient survey had shown that 53 per cent. of adults now rated the food that they ate in hospital as good or very good. The better hospital food programme, which was launched in 2001, introduced five key improvements: 24-hour service, NHS snack boxes, additional snacks twice a day, a hot meal in the evening and menus including three dishes created by leading chefs. So an awful lot is happening with food and nutrition, but I accept the points made by hon. Members that more needs to be done.
	In December, we published our annual operating framework, which recognised for the first time the importance of including regard for the patient experience as one of the NHS's five main priorities. If there is one thing that comes up time and again in consultations and when hon. Members' talk to their constituents about their experience as patients, the quality of food is very high on the list, as well as issues such as how people are treated by staff and receptionists. It is very important that, by including the issue in the five main priorities that the Government have given to the health service, we will see further improvements. Indeed, I held a meeting last week to find out how we could best spread the really good practice that hon. Members are aware of happening throughout the country. I recently visited Cornwall, where the local hospitals are doing an excellent job in serving, I believe, 80 per cent. of locally bought produce, fresh from local farmers, butchers, dairy farmers and fishermen. That is going down very well with patients there, and it is improving recovery rates.
	I want to deal with the claim made by the hon. Member for Eddisbury (Mr. O'Brien) both here and in Committee about patients allegedly being discharged with malnutrition. He made that claim, both generally and in Committee, in reference to my local excellent hospital. It surprised me, and it also surprised the chief executive of the Royal Devon and Exeter hospital. It might be based on a misunderstanding of the definition of episodes. If he will bear with me, it is important that this is put on the record, as the allegations are quite serious.
	For the purpose of the hospital episode statistics, a patient's stay in hospital is referred to as a spell and each period under the care of one consultant is known as a episode. So a patient who is under the care of several consultants during the spell in hospital has several episodes. Someone under the care of only one consultant throughout the stay has only one episode. For the purpose of the statistics from which the hon. Gentleman draws his allegations, the first episode is known as the patient admission episode and the last episode is known as the discharge episode.
	If someone has only one episode in hospital and if they remain under the care of only one consultant during their stay in hospital, their patient admission episode and their discharge episode would be the same. So someone admitted, for example, for the treatment of a nosebleed would have nosebleed recorded as their admission episode and their discharge episode. That does not mean that they leave hospital with a bleeding nose. Similarly, someone whose final treatment episode is registered as being for malnutrition does not leave hospital with malnutrition, as the hon. Gentleman suggested earlier. They are not discharged with malnutrition.
	There may be a number of reasons why malnutrition, for example, is not picked up when someone is admitted to hospital. It might be part of a more serious condition for which they are being treated or operated on, and it is diagnosed only when they are recovering from the more serious condition for which they are being treated or operated on. That explains why their final treatment episode might be for malnutrition, when their initial treatment was not. Hence the allegation made by the hon. Gentleman that people were becoming malnourished in hospital is not the case. Similarly, it might be that, when recovering from a serious operation, a patients loses their appetite, so their final treatment in hospital is for malnutrition, but that does not mean that they are discharged with malnutrition. So I hope that that helps to clear up that point.

Ben Bradshaw: Amendments Nos. 62 to 64 and 143 are Government amendments, so I shall speak to them first. Amendments Nos. 62 and 65 are significant and will be of particular interest to the House.
	On amendment No. 62, clause 2 ensures that the commission must have regard in everything it does to the public's views on the services that fall within its remit, and to their levels of satisfaction with those services. The clause received a great deal of attention when the Bill was considered in Committee. User and carer involvement in the commission's work was also a recurring theme, and hon. Members from both main Opposition parties tabled amendments on that issue.
	As I have made clear on a number of occasions, the Government believe that involving and listening to users, patients, their carers and the public will be a central responsibility for the new commission. The Bill already requires the commission to appoint an advisory committee, and we will expect the commission actively to involve patients and service users as well as others with an interest, such as service providers and commissioners.
	There will be a wide range of bodies with an interest in a particular issue or representing particular groups, and we want to ensure that the commission hears their views. For that reason, Government amendment No. 62 proposes to make it explicit that a duty to have regard to the views of the public includes views expressed by representative bodies on behalf of members of the public. That requires the commission to engage with those acting on behalf of members of the public; that might include local involvement networks, charities or other representative groups. I hope that hon. Members will recognise that the proposed measures are a valuable addition to the Bill that will address their concerns and indeed go further, and I hope that they can accept the amendment.
	Amendments Nos. 63, 64, 66, 67 and 143 are minor technical amendments designed to ensure consistency in drafting with the Care Standards Act 2000, which will continue to apply to children's services and services in Wales. Amendment No. 65 is another significant amendment. When we considered the Bill in Committee, the hon. Member for Romsey (Sandra Gidley) tabled an amendment to oblige the commission to publish its inspection reports. I said that I would be happy to consider the matter, and amendment No. 65 is our response to that commitment.
	Clause 57 requires the commission to produce a report when it undertakes an inspection and to send a copy to the provider or manager in question. As it stands, the clause allows the commission to choose whether to publish the report. As I said in Committee, there is no explicit duty on the current commission to publish reports either, although it normally makes them available online. However, I made it clear that I agree absolutely that the public should have access to the commission's inspection findings. Having had the opportunity to review the drafting, I am happy to introduce amendment No. 65, which will oblige the commission to publish its inspection reports. I trust that hon. Members will feel able to accept the amendment.
	Amendment No. 68 is a consequential amendment that relates to section 134(6) of the Mental Health Act 1983. It will update a reference to section 121 of that Act. It is necessary because the relevant part of section 121 will be replaced, through schedule 3 of the Bill, by proposed new clause 134A. Amendments Nos. 69 to 74 are minor consequential amendments, necessitated by the Bill, to the list in schedule 5.
	I turn to amendment No. 142, the only Opposition amendment in the group. It seeks to allow the Secretary of State to specify in regulations specific circumstances in which the Care Quality Commission would be required to carry out additional inspections; such regulations could be made only after consultation with the commission itself. As I said in Committee, I understand the intention behind the amendmentthat is, to allow an ability to set specific triggers for the commission to carry out additional inspections. However, clause 57 already allows regulations to prescribe important aspects of inspection if necessary; there is no need to be more prescriptive.
	The Care Quality Commission will be established as an intelligent regulator. It will take account of a whole range of information to assess risks in respect of providers and the services that they provide. Based on that, it will decide when and how frequently to visit providers and which issues require more detailed investigation. That will build on the approach already being developed by existing regulators to target inspection when action is required. It will therefore not be for the Secretary of State, but for the commission, on the basis of its intelligence, to determine the appropriate triggers for inspections over and above what is set out in regulations. I invite the hon. Member for Romsey (Sandra Gidley) to withdraw the amendment.

Stephen O'Brien: We are discussing Government amendment No. 62 and the ensuing ones in the group; again, we have a host of Government amendments. Some are concessions that have arisen from Committee, but the question remains about why they had to appear at this late stage.
	In amendment No. 62, the Government are making an important concession on patient and public involvement in health. The Government promised a number of times in Committee to revisit the issue on Report. The drafting of the amendment is, to say the least, disappointingly unambitious. I am concerned that the amendment will open the door for any group that claims to speak on behalf of members of the public to harangue the new commission. We will return to the issue when we discuss the next grouping of amendments, but why are the Government fighting so shy of putting LINksthe bodies that they have createdinto the Bill? Surely that is not because they have no confidence in the bodies themselves. Is it that, as the hon. Member for Tamworth (Mr. Jenkins) pointed out in Committee, the Government are worried that the bodies will be disbanded in the near future, following hard on the heels of the community health councils and the forums?
	I hope that the Minister will expand on amendment No. 68; in Committee we had a number of discussions on the withholding of mail from prisoners detained under the Mental Health Act 2007, an issue of specific concern to the current Mental Health Act Commission. Can the Minister guarantee that the status quo will not change?
	The hon. Member for Romsey (Sandra Gidley) tabled amendment No. 142 to clause 57, which is concerned with regulation. Clause 64 is entitled Avoidance of unreasonable burdens in exercise of regulatory powers. We have proposed that when the CQC increases regulation, an affirmative resolution should be brought before the House. We have found that the Government were most resistant to that idea; as I have placed that on the record, I hope that the matter will be taken up with alacrity and fierce argument in another place.
	The amendments on the CQC go hardly any way towards addressing the many and deep concerns expressed by the Committee and a number of third-party organisations; the letter published in today's issue of  The Guardian testifies to that. It seems to suggest that the Government have lost the confidence of a lot of members of the voluntary sector. There is still no mention of carers among the skeletal functions of the CQC, listed in clause 2. I say skeletal, because for the most part this is skeleton or portmanteau legislationthe body is to be added later, by regulations. That is most noticeable in clause 2, which establishes no overarching function. Indeed, the advertisement for the chair of the commission, already online despite the fact that the Bill has not been passed by either House, states that one of the role's responsibilities will be developing plans for the development of the commission's functionsan interesting job spec if ever there was one.
	There are still real concerns that social care and the work of the Mental Health Act Commission will be squeezed out in the action of the new commission. To ameliorate the problem, we have sought a separate reference board of commissioners and an executive board to run the commission. Despite the Minister's contention that the CQC is to be free to establish its own direction, the Government have not left space in the legislation for it to establish the most effective system of corporate governance. Furthermore, there are real concerns that the Government are playing politics with the merger, and ultimately with the well-being of patients and service users, through the prevention of special reviews until after 2010that is, after what will be an increasingly rocky election period for a failing Government and a dithering Prime Minister. We will seek to overturn the issue in another place to prevent that politicking from influencing the important substance of the Bill.
	Dame Denise Platt of the Commission for Social Care Inspection has expressed concern that many of the commission's functions will become permissive rather than statutory, as they currently are, and that they will therefore be the first to be ditched when the Government put on the financial squeeze. The Government seem unable to get the issue right. What guarantees can the Minister give that they will not scrap this in three years' time?
	The 1998 White Paper Modernising Social Services proposed structural change. The Care Standards Act 2000 created a single England-wide National Care Standards Commission, which was launched in 200217 days later, the Government announced that it was to be abolished. The Health and Social Care (Community Health and Standards) Act 2003 created the Commission for Social Care Inspection, which was launched in 2004, incorporating the social care responsibilities of the National Care Standards Commission, the work of the Department of Health social services inspectorate and the SSI-Audit Commission joint review team. In 2004, the Government's arm's length body review ruled out a merger with the Healthcare Commission. In his 2005 Budget statement, the then Chancellor announced the merger that we are debating today. Need I say more? Can the Government guarantee that all the work that we are putting in today will not be scrapped within three years?
	This scandalous provision remains in the Bill. It forces the CQC to have regard to such aspects of Government policy as the Secretary of State may direct; as such, it totally undermines the independence of the body. The Healthcare Commission has put on record its concerns about the timing of the legislation and that the costs will be high and the distraction considerable. It was disappointing therefore that the Government chose not to include the cost of the merger with wind-up costs of 140 million in any risk assessment.
	The House should also be aware that the merger is saving almost nothing on the efficiency trend that the three commissions themselves have already established just as they were bedding in. Taxpayers are paying 140 million for a merger and rebrand that will probably save them no extra money. Furthermore, parts of the cost savings are due to the commission losing the responsibility for complaints handling. That will be transferred to the ombudsman, but we have had no costings on the increase of her budget in the face of an elevenfold increase in work load. We also have no information on how this will be wound up and transferred.
	Despite all their amendments, the Government have yet again not got things right. They have not had sufficient ambition when they have sought to address the concerns that have been raised. I hope that the Government have only put down a marker for what will be truly beefed up, made proper and substantive in another place, so that health care needs are met and patient representation and protection are secured.

Stephen O'Brien: I am grateful to you, Mr. Deputy Speaker, and I apologise for the fact that I had to absent myself briefly from the Chamber towards the end of the debate on the previous group of amendments.
	We come now to Local Involvement Networks, and it will not have escaped your notice, Mr. Deputy Speaker, that we had a partial discussion about them in relation to Government amendment No. 62, which sought to make clause 2 read:
	In performing its functions the Commission must have regard to
	views expressed by or on behalf of members of the public about activities to which the functions relate.
	I pay tribute to the co-sponsoring of our amendments by the hon. Members for North (Kelvin Hopkins), for North-West Leicestershire (David Taylor) and for Romsey (Sandra Gidley). Amendment No. 131 would make it explicit that LINks were one of the groups that the commission must have regard to. Amendment No. 132 would include LINks as a group that the Office of the Health Professions Adjudicator must seek the views of, and amendment No. 133 is consequent to that. Amendment No. 134 would include LINks as a group that the Commission for Healthcare Regulatory Excellence must seek the views of from time to time, and amendment No. 135 is a consequential amendment. Amendment No. 136 defines LINks for the purpose of part 1, and amendment No. 137 defines them for the purpose of part 2.
	I welcome the concession that the Government have made to the arguments advanced by me and Committee members of all parties that LINks should be consulted by the Care Quality Commission. Unfortunately, having promised a number of times in Committee to revisit the issue on Report, the Minister has been disappointingly unambitious in his amendments, which were accepted without opposition. I will not suggest, therefore, that those amendments show more of the contempt that many, including myself, have accused the Labour Government of showing in their treatment of the patient voice in England. They scrapped community health councils, which I was very involved with. I exposed an answer given at Prime Minister's questions: the Prime Minister said that there had been consultation when it was announced that they would be axed in the July 2000 NHS plan, but there had not.
	The patient and public involvement forums are now also to be replaced, and if LINks are not mentioned in the Bill, the Government's latest solution could appear as a vote of no confidence in them. That perception is held by the hon. Member for Tamworth (Mr. Jenkins), who noted in Committee that the reason for not prescribing LINks in the Bill was
	in case it ceases to exist during the lifetime of the Bill. [Official Report, Health and Social Care Public Bill Committee, 17 January 2008; c. 284.]
	The hon. Member for Luton, North, who is co-sponsoring the amendments, told the Committee that
	ever since the community health councils were abolished Labour Members have been concerned about the strength of protection for patients and of patient representation. [Official Report, Health and Social Care Public Bill Committee, 22 January 2008; c. 412.]
	I admire him for saying that. He is right and it needed to be said.
	I will not rehearse the arguments made in Committee, but simply note a few essential points in support of the amendments, the most vital of which is amendment No. 131. In December 2005, an independent review of the regulatory framework of the NHS, ordered by the Department of Health, concluded:
	Establishing representative national and regional fora to contribute a reasoned collective consumer perspective to the process of reform could well improve both the efficacy and legitimacy of that reform.
	In their response to the consultation preceding the Bill, the Government stated:
	The Care Quality Commission's...priority will be to safeguard service users and help improve their experience of health and adult social care servicesrecognising that it can only do this effectively by involving them.
	I note that Ofcom has a consumer panel that plays a similar role, which convenes a regular consumer forum of interested parties, such as consumer and disability organisations.
	In its written evidence to the Committee on this Bill, the Healthcare Commission stated it considered the first clear principle
	underpinning the design of a regulatory framework
	to be that the
	regulatory system should focus on the needs of the patients and the public.
	The Commission for Social Care Inspection put it even more strongly:
	It would be useful if there were an explicit expectation that the new care Commission had a relationship with Local Involvement Networks.
	That is precisely what our amendments seek to achieve. It is clear that there is a genuine and grand opportunity for the Minister to accept that the amendments are workable and desirable.
	The Government are giving a vote of no confidence to their own system by leaving LINks out of the Bill, which is another nail in the coffin of genuine patient and public involvement. As I said, that process began with the abolition of CHCs. We are disappointed that the Government have not used the opportunity offered by this Bill to steal our policy of creating HealthWatch, a national consumer voice for patients. HealthWatch would provide support to patients at a national level and leadership to LINks at a local level. It would incorporate the functions of the independent complaints advisory body; make representations to the NHS board on such things as the closure of NHS services; and, subject to consultation, it would have a statutory right over guidelines issued nationally concerning the care NHS patients should receive and over decisions that affect how NHS care is provided in an area. Hopefully, the Government will support us when we introduce our NHS autonomy and accountability Bill. That would be welcome, and consistent with what the Government are purportedly seeking to achieve.
	Now that the Government amendments have been accepted, I am concerned that the door is open for any group that claims to speak on behalf of members of the public to harangue the new commission, or engage it in some difficult dialogue. We also note that there is no duty to consult, only the weak phrase have regard to. That weakness is repeated in relation to other organisations mentioned in the Bill. The hon. Member for Luton, North, who has studied the matter carefully, pointed out in Committee that clause 103, which deals with the OHPA, is entitled Duty to consult and contains the phrase seek the views oftwo very different things. A similar wording is used with regard to the CHRE. The title of clause 112 talks of a duty to consult, but again we find the phrase seek the views of in the text of the clause.
	Our amendments would beef up the consultation carried out by such bodies by including LINks. I commend the amendments standing in my name and those of my hon. and right hon. Friends, and Members from the Labour and Liberal Democrat Benches. This is a genuine cross-party approach to the matter, so I hope that the Government will feel persuaded.

Kelvin Hopkins: I have agreed to attach my name to the amendments, alongside that of my hon. Friend the Member for North-West Leicestershire, because Members in my party have been some concerned about the strength of patient representation for some time, and it is right that those concerns are raised from time to time so that the Government are made aware of them. The abolition of community health councils and the switch to the patient and public involvement forumsand now to LINksshow that the Government are concerned about patient representation, but I am not sure whether they want to strengthen it, or have had pressure put on them to weaken it in some way.
	I know that the then health authority perceived the community health council in my area to be a nuisance. The primary care trust has regarded the patient and public involvement forum in our area, especially its chair, as a nuisance. However, patients' representatives should be a nuisance. If they make a lot of noise, perhaps there is a basis for what they are doing. I hope that my hon. Friend the Minister and the Government will reconsider giving a role to LINks in the way in which the amendments suggest. Perhaps they will table their own amendments if the ones that we are considering are defeated.
	I repeat a point that I have made several times about local authority democratic accountability. When most long-term care homes were in the public sector, there was recourse to local councillors and local democratic representation. With privatisation and subsequent institutional reform, that local democratic accountability was lost. Indeed, many families now come to their Members of Parliamentmore than one constituent has approached meabout problems with care homes. There should be a stronger role for patient representation and I hope that that view can be accommodated in the Bill before it receives Royal Assent.

Ben Bradshaw: The amendments will allow the Office of the Health Professions Adjudicator to appoint and use legally qualified chairs for panels hearing fitness to practise cases. The Bill as introduced provided for chairs to be chosen from either the lay or professional lists, with the panel having a legal assessor to advise on points of law. However, I thought that the evidence given to the Committee by Lady Justice Smith and the General Medical Council warranted further thought. Lady Justice Smith said that
	there are many reasons why I think that we should have a legally qualified chair, the main one being that to do the job well requires legal expertise. [Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 41.]
	Findlay Scott, the chief executive of the GMC, said that
	if there is an argument for a legally qualified chair, I do not personally believe it lies in the quality of the decisions. There may be real arguments in relation to the ability of a senior lawyer to control the proceedings in a way that constrains costs while remaining fair to doctors, and I think that that is an argument that deserves to be fully explored. [Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 57.]
	I therefore agreed in Committee to give careful consideration to that issue, with a view to bringing something back now. That is what these Government amendments represent, and I think that they are a good example of how the evidence-giving process is adding value to the system of parliamentary scrutiny.
	Essentially, the amendments require the OHPA to keep a list of chairs, which will include legally qualified chairs as well as lay and professional chairs. The OHPA will then have the flexibility to set out in rules when it will use legally qualified chairs. I am very clear that it would not be right for the Government to impose legally qualified chairs for every case that OHPA hears, when this is a relatively untried and untested route in this arena. Instead, the amendment gives the OHPA the option of using legally qualified chairs for as many cases as it thinks it appropriate. For example, the OHPA may set out in rules that all cases involving a high number of witnesses or likely to be particularly lengthy should have a legally qualified chair. However, the rules may also set out that in all cases where the health of the practitioner is the central issue, a lay or professional chair should be used.
	The essential point is that, although I agree that legally qualified chairs should be available to the OHPA, we do not think it right for the Government to prescribe exactly what kind of chair should be used in which circumstances. I would regard it as particularly inappropriate to require the OHPA to use legally qualified chairs in every case before they had been properly trialled and a decision made in the light of practical experience. I hope that Opposition Members will support the amendments.
	Let me deal now with Opposition amendments Nos. 75, 82 to 85, 87, 89 and 90. I hope that the hon. Members who tabled those amendments will agree that the Government amendments very much achieve the same objective, so they will feel content not to press their amendments. Amendment No. 85 appears to be designed to ensure that all panels should have a legally qualified chair in all cases. I apologise if I have misunderstood the purpose of the amendment, but it seems to be at cross purposes with amendment No. 82. I do not propose to detain the House by rehearsing my reasons for opposing the amendment, because I have already set out in speaking to the Government amendments why I do not believe it is right to impose legally qualified chairs in all cases.
	Amendments Nos. 75 and 87 would set in stone the requirement for legal chairs to have a 10-year general qualification, which is the same requirement as the General Medical Council currently uses for its legal assessors. However, the General Optical Council requirement for its legal assessors is a five-year general qualification. I am concerned about prescribing a narrow requirement on the face of the Bill, especially when I have tasked the Tackling Concerns Nationally working group under the chairmanship of Sir Ian Kennedy to consider the introduction of legal chairs and other such details. Ultimately, we believe that it should be for the OHPA to decide how best to run its fitness to practise panels within the framework set by Parliament, taking into account the recommendations of the working group. Rules covering the detail will be laid before Parliament and will be subject to the negative resolution procedure.
	Amendments Nos. 89 and 90 would require all health profession regulators using the civil standard of proof to have legal chairs or at least legal assessors in all cases. I remind the House that the majority of these regulators already use the civil standard. I am sure that Opposition Members do not want to push the whole swathe of regulators into the unknown. If the evidence pointed in such a direction, powers under section 60 of the Health Act 1999 could be used after appropriate consultation. As hon. Members are no doubt aware, a section 60 order will be subject to the affirmative resolution procedure. On that basis, I hope that the Opposition will not press their amendments.

Stephen O'Brien: This group includes Government amendments as well as those tabled by my hon. Friends and myself. The amendments arose as a result of the evidence-taking sessions. As the Minister pointed out, they help to reinforce the value and benefit of such sessions. I welcome the beginnings of an important concession by the Government to the strength of our arguments on legally qualified chairs. I remind the House that the Committee divided on this matter in order to hold the Government's feet to the fire during the sitting.
	I shall not go over the arguments again at length, as they were covered more than adequately in the  Hansard of Committee proceedings from column 372 onwards. However, the provisions on legally qualified chairs arose from recommendation 79 of the fifth report of Lady Justice Smiththen Dame Janet Smithon the Shipman inquiry. She said:
	In the event that the GMC retains control of the adjudication stage, it should appoint a number of legally qualified chairmen who should, as an experiment or pilot, preside over more complex FTP panel hearings. The results of the pilot scheme should be scrutinised to see whether there are benefits, whether in terms of the improved conduct of hearings, more consistent outcomes, improved reasons and/or fewer appeals.
	All hon. Members felt that there was extraordinarily impressive and persuasive oral evidence relating to effective chairmanship, speed of proceedings, a higher standard of reasoned decision and an ability to deal with the complexities of the civil standard of proof. That evidence can be seen in column 37 of the  Official Report of Committee proceedings.
	It will not have escaped the notice of the House that one aspect of introducing the civil standard of proof in the hearings is the complexity of its administration as a matter of adjudication and law, not least in ensuring that justice is done and seen to be done. As I shall try to explain, it has variability within it, unlike what we used to call the criminal standard of proof, of being beyond all reasonable doubt, or as is more common nowadays, the standard of being sure.
	I am pleased that the Government have introduced proposals for a list including legally qualified persons. The Minister has outlined that point in speaking to Government amendment No. 23, which was a response, as he knows, to the demands we made in Committee at column 374 of  Hansard. Nevertheless, I have to say that our amendments Nos. 82, 83 and 84 are a neater way of delivering what he has sought to achieve in Government amendment No. 23. That amendment is intended to supplant, from the Government's perspective, our amendments Nos. 82 to 84, so I believe that we should see these a coupled set of arguments. I am pleased that the Government amendment was designed to draw on the arguments made in Committee, as reflected in the amendments.
	A number of concerns remain, however, particularly about the application of the civil standard of proof, the speed of proceedings and the definition of legally qualified. On the standard of proof, the Bill moves fitness to practise panels away from the criminal and towards the civil standard of proof. In layman's terms, it is a move from beyond reasonable doubt or being sure to a balance of probabilities. We debated that point in Committee, as is shown in column 395, but unresolved issues remain and it is right for us to bring them up again on Report.
	There seem to be good reasons for the use of the civil standard and few differences between the parties arose in Committee. Indeed, Opposition Members supported the Government, but we remain concerned about the lack of piloting, particularly with regard to doctors. That problem still needs to be dealt with. I hope those reflecting on the Bill as it goes to the other place will give that issue some further urgent and important consideration.
	The concern arises because a statutory application of the civil standard results in a common law interpretation on a sliding scale that is difficult to reflect on the statute book. Consequently, a doctor before a panel faces an ever-rising hurdle in attempting to clear his or her name. The civil standard of proof will not be applied uniformly across the boarda very important point made by Lady Justice Smith in her evidence at column 38. This issue is important not just for the doctor, but for those sitting on the panels. They must have a clear understanding at the outset of what standard of proof on the balance of probabilities actually means on a sliding scale. Until they know the evidence, they cannot be sure of the standard of proof against which the truth must be tested. That is critical in the ultimate case where someone's livelihood is threatened and their fitness to practise questioned. There is a burden on adjudicators to ensure that their decisions are just and fair, made in a properly conducted way and, above all, not capable of being contested too easily by appeal. People must feel that the system is proper and fair to both parties when these very serious issues come before these panels.
	Another reason Lady Justice Smith gave for the use of legally qualified chairs was enabling hearings to be dispatched more quickly. We are all interested in securing efficiency and speed in such things, without causing any prejudice to the application of justice. She said:
	Legally qualified people who appear in front of such tribunals are capable of running rings around the tribunal if no one on the panel is legally qualified. [Official Report, Health and Social Care Public Bill Committee, 8 January 2008; c. 37.]
	The GMC, which has lobbied against the universal application of legally qualified chairs, has failed to answer that pointsomething to which she also referred. She went on to say that while it is true that the broad quality of judgments currently made is indeed highI am in no way seeking to criticise the GMC for the conduct of its hearings and how it has trained peopleit would be better for all concerned if panels could be conducted no less thoroughly but more efficiently.
	It is with the issues of speed, efficiency and the application of the civil standard of proof in mind that we tabled amendment No. 85, which would make all fitness to practise panels subject to a legally qualified chair. Interestingly, to add substance to that point, page 4 of a document supplied by the Government themselves on 7 February in relation to professional regulation shows the cost of a three-person panel with a legally qualified chair for some fitness to practise cases and the cost of a three-person panel with a legal assessor for the remainder. Where legal chairs are used in 10 per cent. of fitness to practise cases, the estimate is 2.565 million. If they are used in 25 per cent. of fitness to practise cases, the estimate is 2.489 million, and it comes down to 2.374 million if they are used 50 per cent. of such cases. That helpful Department of Health document implies that if we used legal chairs in 100 per cent. of such cases, it would have the same trend in saving money and, as Lady Justice Smith would argue, in the increased dispatch, speed and efficiency of the cases. Therefore, the Department of Health itself has already laid out a good taxpayer value-for-money point on how it would be more efficient to use legally qualified chairs in all cases.
	I am disappointed that the Government are unwilling to define legally qualified in their amendment No. 30. Amendment No. 75 would help us to have that definition, and links to amendment No. 85, which would ensure that there is a qualified chair for all such cases. The Bill is in many regards a portmanteau Bill, with many of its powers devolved to rules and regulations. More than a quarter of the clauses relate to secondary legislation. It is perverse to leave to regulation what could easily be prescribed on the face of the Bill under the proper scrutiny of the House.
	The Bill contains a definition of legally qualified in paragraph 6 of schedule 6. Lady Justice Smith noted and commended that definition in oral evidence, at column 39. In Committee, my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), who is not in the Chamber but has been assiduous in his attendance of our proceedings, made the excellent point that a legally qualified chairman would need not only legal experience but judicial experience. It is important to reflect on that.
	Having taken considerable advice, I had hoped that as Government amendment No. 23 went some way to making a concession on the grounds that we have advanced, I would not have to oppose it. However, I wanted to put amendment No. 85 to the vote, because what it contains is right and many outside this place would like to see it tested. Unfortunately, I am told, on the advice of the Clerks, that I cannot do that, which is much to be regretted. Procedure has overwhelmed what is a fair point, which should be available for testing. However, having put that difficulty on the record, I hope that it will be seen by those in another place who are exercised by such things. Many of them regard themselves as legally qualified and as having judicial experience. They will think that it is important to envisage how these significant proceedings will work, because they could be vital to protect patients and the public.

Stephen O'Brien: I do not want to enter into a dialogue. What matters is that plenty of people in another place will be very exercised by this issue, given that Lady Justice Smith gave important and compelling evidence in a most reasoned way. When we heard her evidence, hon. Members on both sides of the Committee were at one that it was impressive and compelling. She advanced the idea that there should be legally qualified chairs for the bodies. That is why it is important that we give the issue an airing.
	Procedure does not enable us to vote separately on Government amendment No. 23, which is only a partial solutionwhat it sets out is not mandatory; it simply says that there will be legally qualified persons on a list from which the chairman can be chosenand amendment No. 85, which would have made that mandatory. It would have given earnest to what Lady Justice Smith appeared to be advising in oral evidence, for which all Committee members were present. I therefore recognise that I have to place on the record, with my best efforts, a signal to those who will consider the Bill in another place. I know that this sort of issue has exercised them greatly in the past, and rightly so. I would be surprised if we do not have to deal with it again when the Bill comes back to the House with Lords amendments. I very much hope that it will be given a proper airing in the other place, and I expect them to find a way to achieve what procedurally I have not been allowed to do.
	I cannot press amendment No. 85 to a vote, and on the basis of my comments it would be wrong and invidious of me to divide the House on Government amendment No. 23. If anyone sought to put that to a vote, we would abstain because it is better than what we have got, but it is by no means sufficient. I hope that that places on the record our position and that another place will achieve what we have not been able to achieve so far.

Stephen O'Brien: As I am sure the House knows, the General Medical Council is a registered charity. Over time, other health regulators that may also be charities will come under the auspices of the OHPA, and will be required to pay a fee to that body. All registered charities have duties in relation to how they spend their income, and the GMC and other regulators are no exception, but the Bill contains provisions that directly affect the way in which the GMC should spend a significant proportion of its income, while leaving it little if any discretion in respect of how it does so.
	Given that the OHPA's duties will mirror functions that already sit within the charitable body, the funding of a non-departmental public body such as the OHPAwhose purpose is to uphold the standards of a health professionis clearly unlikely to fall outside the charitable remit. However, it would seem wrong to place a burden on the GMC or another regulator that might have the potential to jeopardise its charitable status without making clear that that was not Parliament's intention.

Stephen O'Brien: I am not sure how closely the hon. Gentleman has been following the debate. He ought to know that, as has been repeatedly put on record, we have strongly supported a change in the rules. I am a little perplexed about how the question could even have entered his mind, but perhaps he has not been able to follow the Bill's progress as closely as his question might have merited. We have not voted against the Bill, and we welcome the changes. What I am talking about is charitable status, which I hope is deeply important to the hon. Gentleman. If the GMC is not a charitable body, there will be a series of consequences.
	Let me proceed with my argument. It may help to clarify any confusion that may have arisen in the hon. Gentleman's mind. The Government may argue that we should not bind the hands of the Charity Commission, a body that operates independently of Ministers, but there are clear precedents for such action in other legislation. For example, further and higher education corporations are designated charities under section 41 of the Teaching and Higher Education Act 1998, and common investment funds are classed as charities under section 24 of the Charities Act 1993. Amendment No. 81 is intended to prevent the operation of fees from introducing any ambiguity to the designation of the GMC as a registered charity.
	As the Liberal Democrats tabled amendment No. 2, it will be for a Liberal Democrat Member to speak to it. The others are Government amendments. While most of them appear to be tidying-up measures, amendment No. 48 appears to disqualify hon. Members from sitting on OHPA adjudication panels. I do not believe that involvement with the OHPA is prohibited by membership of the House of Commons, and I should be grateful if the Minister could explain what changes the Government intend. If the answer is not satisfactory, I dare say that the matter will be pursued in another place, but, as the Minister must be aware, some Members are currently involved in the adjudication processes of the GMC.
	We also need to tackle the issue of the costs of the OHPA. I thank the Minister for furnishing us with the report on the costs that we had requested, although I was disappointed that we did not receive it before the Committee stage. I hope that he will be able to provide the independent report by financial advisers engaged by the GMC, which was supposed to be available at the end of January and which is mentioned in column 365 of the record of our Committee proceedings.
	The Government report divides the costs into three groups: set-up and transition costs for the GMC, other costs to be paid by the Department, and adjudication and running costs. The set-up costs, the Government finally reveal, will be about 3 million to 4 million over two years, but they are to be further refined. The other costs, such as those of High Court referrals or big cases, have not been estimated, and I should be grateful if the Minister could identify the nature of that liability. The adjudication costs are not expected to exceed the current GMC costs of around 11.5 million. The running costs are not identified, which is odd, but the paper does identify a probable increase of between 20 and 30 per registrant per year. That would increase the General Medical Council registration to more than 400 and that of the General Optical Council to almost 200. A full GMC registration on the medical register is to rise to 390 a year with effect from April this year, having been frozen at 290 since 2002, and GOC registration stands at 169 per annum. It also suggests running costs for the OHPA of about 6 million per annumI hope that the Minister will be able to confirm that figure.
	We remain deeply unsatisfied about the independence of the OHPA. We have searched Government amendments for where the Minister might give assurances about the independence of its decision making, but as the organisation is created the Department will needlessly still have its hands all over its finances. That is neither necessary nor desirable. Concerns remain over the civil standard of proof, which we discussed earlier and the Government failed to address. We were also looking for permanent legally qualified chairs, but we have now assented to a different situation.
	The Government must recognise that as the Bill progresses a full response is required on professional regulation and the impact that the practice of defensive medicine might have on our NHS, particularly financiallyI hope there will be time to provide that when the Bill is considered in another place. I am sure that the Minister recalls that this was one of the areas of greatest contention during oral evidence sessions, and I think all Members were concerned about the BMA presenting the idea that the new regime would create over-defensiveness. I do not wish to be too criticalthose giving that evidence must have thought that they were making representations on behalf of their membersbut we need to bottom out what has been expressed on behalf of doctors about the impact of what is going on in terms of defensive medicine because we do not want that, and I do not believe it is likely to be a trend or a consequence; I would not be able to support the Bill if I did. Although I do not believe that to be the case, it is important to take such representations seriously and address them, rather than simply dismiss them out of hand. If necessary, we might have to appeal, through the BMA, to make sure that doctors are reassured that they need not be over-concerned about that. I have been getting the impression that the Minister might feel that that is a worthwhile point, which is good.
	The Government amendments on professional regulation would give the power through secondary legislation to impose a lay majority on the regulatory bodies. The GMC has been arguing for parity, and that makes sense for the confidence of both the public and the profession. I dare say that that will be pursued in another place.
	I have spoken to amendment No. 81 and I have addressed the other issues that arise. If the Minister does not provide a satisfactory response on the charitable status of the GMC, I might need to press the amendment to a Division.

Amendments made: No. 73, page 188, line 39, at end insert
	
		
			 'Audit Commission Act 1998 (c. 18) In section 4(7) 
			  (a) in paragraph (a), the words the Commission for Healthcare Audit and Inspection and, and 
			  (b) in paragraph (b), the words the Commission for Social Care Inspection and. 
			  In section 49(1) 
			  (a) paragraph (ba), and 
			  (b) in paragraph (c), the words from or for the purposes of the functions of the Commission to the end. 
			  In Schedule 2A, paragraph 1(1)(g) (together with the word or at the end of it).'. 
		
	
	No. 74, page 189, line 44, at end insert
	
		
			 'National Health Service (Wales) Act 2006 In section 30(2), paragraph (d) (together with the word and at the end of that paragraph). 
			 Safeguarding Vulnerable Groups Act 2006 (c. 47) Section 45(7)(d). 
			  In Schedule 4 
			  (a) paragraph 1(10)(f), 
			  (b) paragraph 1(11)(a), and 
			  (c) paragraph 7(6)(a) and (b).'. 
		
	
	No. 60, page 190, line 2, column 2, leave out '(7),' and insert '
	
		
			  (a) in subsection (7),'. 
		
	
	No. 61, page 190, line 4, column 2, at end insert ', and
	
		
			  (b) subsection (8).'. 
		
	
	. [Mr. Watts.]
	 Order for Third Reading read.

David Taylor: I apologise for not being in the Chamber for about a minute at the start of the debate. We moved on to Third Reading rather more speedily than most people had expected.
	Public trust is central to rebuilding public confidence in our system of professional health regulation. However, the way in which the Department of Health has gone about addressing that challenge in the past two years has sometimes had the opposite effect. My contribution on Second Reading and the amendments tabled to clauses 105, 106 and 108 were designed to support the Council for Healthcare Regulatory Excellence's capacity to be, in the words of the White Paper, a truly
	authoritative independent voice for patients on the regulation of professionals, providing expert advice on policy.
	To date, the Government have neglected an important opportunity to renew democratic accountability, perhaps in their desperation to retain central control.
	At the citizens councils meeting that I organised in Committee Room 17 on 8 January 2008, underlying a great deal of issues raised by informed patients and public members, on which reassurance is sought, were five themes that are particularly relevant to the aspirations set out in the original White Paper. I wrote to the Minister about these matters on 6 February and I will no doubt hear from him.
	First, astonishingly, the CHRE is yet to agree a patient and public involvement strategy. How will the patient and public arrangements that it puts in place be sufficiently independent and at arm's length from the Government, regulators and the CHRE itself to provide an assurance that the real concerns of informed patients will be addressed?
	Secondly, will the process be sufficiently well resourced to cut through often complex technical jargon so that participants are informed and have a capacity to develop a patient-centred position? Thirdly, how will the CHRE's PPI arrangements enhance existing public and patient engagement strategies in Scotland, England, Wales and Northern Ireland with a commitment that they will actively facilitate communication among representatives from each country, respect the differences and similarities between each country, and be tailored to meet their specific needs?
	Fourthly, we know that the number of the oldest and most vulnerable people requiring care will inevitably increase substantially. What assurances have the Government sought and received from the CHRE that it will be able to ensure that such vulnerable groups are identified and that specific measures are put in place to address their needs?
	Fifthly, what further systems of parliamentary accountability will the CHRE and the regulators be subject to if the Bill is passed in its current form? If there is a Division on Third Reading, I shall vote for the Bill. I voted against amendment No. 131, to which I put my name, because I accepted the Government's reassurances. However, if we are to have a Standing Committee, why is it to be of both Houses of Parliament? What is meant by oversee? Does the Minister agree that there is a need for innovative techniques to ensure that the public and patient voice is heard in the process?
	Sixthly, is the Minister aware of the implications of the CHRE not putting in place an effective PPI strategyincluding independent arrangements and practical support to ensure that a strong patient voice is heardthat will command public confidence and the support of the devolved Administrations in Scotland, Wales and Northern Ireland? The proposed CHRE membership is far too small for the council effectively to reflect the diversity and breadth of views in a sector employing 2 million people and stretching across four countries. In the Bill, officials propose an inappropriate NHS trust-type model, which will have insufficient members to ensure a clear distinction between remuneration and audit committee functions. That is why it is disappointing that the Minister did not respond positively to the amendments to clause 106 tabled in Committee by my hon. Friend the Member for Luton, North (Kelvin Hopkins).
	Will the two CHRE executives allowed to be non-executive council members of the public body be a truly
	authoritative independent voice for patients on the regulation of professionals, providing expert advice on policy,
	when all CHRE executives already speak at council meetings? Why has the White Paper implementation website been such a calamity, preventing anyone outside a magic, private policy circle from contributing to debates preparing us for discussions such as this one, despite the promise of inclusivity given at the national White Paper implementation advisory conference on 5 June last year?
	The lack of urgency means that work streams have made very little progress, giving the impression that they are window dressing while real decisions are being taken elsewhere. How can Parliament debate health regulatory corporate governance issues properly when the internal report sent to Ministers in November last year is unavailable for this debate? If the report proposed a Standing Committee of both Houses of Parliament, why are we being denied the opportunity properly to scrutinise that recommendation?
	Does the Minister agree that it is no longer good enough to continue to define lay as not on our register? If so, what changes are required in the criteria to be used in appointing new lay and public members to the regulatory bodies and the CHRE, and when will Parliament and the wider public be able to comment on such criteria before the Appointments Commission adopts them? Why are lay and public members expected to reflect a wider perspective across the four countries, rather than representing the interests of patients and the public?
	It is a well-intended Bill, no doubt, and it will tackle some of the concerns that were well debated in CommitteeI attended some sittings, as well as Second Reading and tonight's debatewith a degree of competence and professionalism, but I shall back the Bill and go through the Lobby, if there is a Division on Third Reading, without significant enthusiasm. I believe that in the Labour Government's fourth term, in two and a half or three years' time, another Minister will be back to tackle the matter yet again with community health councils, mark 4. I do not think that the Bill is the way ahead. An opportunity has been missed. Although the Minister has explained the Government's rationale very well to the House and the Committee, I find it unconvincing.

Sandra Gidley: I thank all those involved with the Bill, including my hon. Friend the Member for Leeds, North-West (Greg Mulholland), who led debate on various aspects of the Bill in Committee. I also thank Conservative Members and the Minister for what have been on the wholethere were a couple of notable exceptionsrelatively good-natured proceedings. A genuine attempt has been made to get to the bottom of some of the issues, and I thank the Minister for taking on board some of our concerns. I would also like to put on record my thanks to the Committee Clerks, who were unfailingly helpful and approachable. My only concern is that the selection of amendments on Report left a little bit to be desired. Some of us would have liked to discuss certain aspects of the Bill in greater depth, such as the health in pregnancy grant, but that was not to be; that pleasure has been reserved for the other place.
	Although the bulk of the Bill is involved with the setting up of the Care Quality Commission and deals with health care regulation, it is also worth mentioning in passing the bits that were also important but have not attracted as much attention. I am thinking of health care-acquired infections and the public health measures as well as the health in pregnancy grant, which I have mentioned. The Bill also includes provisions on the measurement of childhood growth and the way in which the global sum is allocated to PCTs for pharmaceutical services.
	Although the evidence sittings were useful, the Committee stage was somewhat frustrating because not a single Opposition amendment was accepted. However, I have to be fairwhen the Minister said that he would reflect on an issue, he sometimes came back with Government amendments. They did not always meet all our concerns, but they were a welcome step in the right direction. Those amendments dealt with reports to the commission, and we have seen movement on legally qualified chairs. We have been promised some movement on the issue of human rights in care homes, which concerned Committee members on both sides of the House.
	I should like to conclude by talking generally about the Care Quality Commission. The Liberal Democrats supported the principle of the commission three years ago. As the Minister said earlier, we were asking the Government, Why do you not do this now? Both the Healthcare Commission and the Commission for Social Care Inspection are starting to perform well. Although I support the principle of joined-up administration and regulation, there are genuine concerns about how the transition should be handled. In the changeover, we should not lose the efficiency and effectiveness of the two organisations.
	We already know that the transition costs are likely to be 140 million. What concerns me more is the massive disruption to the two organisations and the staff involved. At this point, it is pertinent to reflect on Ian Kennedy's statement for the Public Bill Committee:
	What we will see will be a period of flux: senior staff will need to be recruited and then appoint others; managers will be organising 'away-days' and locked in meetings over organisational design and conditions of employment, instead of meeting the accelerating demands and expectations of patients. Morale in existing organisations will be increasingly hard to sustain. Good members of staff are already leaving, taking with them the knowledge that it has taken three years to develop.
	The issue is a concern to us all. The memory of the organisation of PCTs is still fresh: there was a period of stasis in many areas, while people, rightly, fretted about their jobs and reorganised. That put a halt to some of what the Government were trying to achieve.
	We must not make the same mistake with this reorganisation. Much has yet to be decided by secondary legislation, so there is still great uncertainty. All the people who work in the field and are likely to work for the new commission need as much certainty as possible as early in the process as possible. To deny that certainty would have a knock-on effect on patients and the public.
	It is probably worth reminding the House of Ian Kennedy's concluding remarks:
	the reasons for the Bill are unclear...the costs are high...the distraction is very considerable...the risk of harm to patients is significant. We believe that the Committee should seek to be satisfied that each of these matters has been properly taken account of and that the concerns expressed here are unwarranted.
	While the reasons for the Bill are fairly clear, as regards costs, distraction and potential harm to patients, I am not sure that I can put my hand on my heart and say that we have done full justice to those concerns in Committee. There will be continued scrutiny in the other place, and we may yet see aspects of the Bill come back. I give a cautious welcome to the Bill but seek reassurances that some of these concerns will be addressed.

That the draft County Durham (Structural Change) Order 2008, which was laid before this House on 8th January, be approved.
	That the draft Northumberland (Structural Change) Order 2008, which was laid before this House on 8th January, be approved. [Mr. Blizzard.]
	 Question agreed to.
	 Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Motion made, and Question put forthwith pursuant to Standing Order No. 119(9) (European Committees),

Denis Murphy: I thank Mr. Speaker for granting me the debate. The case that I am raising relates to an individual constituent, Mrs. Susan Hurrell, who I believe has been the victim of a major injustice at the hands of Scottish Provident. I do so with her agreement and the issue is not subject to any form of legal proceedings. I shall briefly explain the unfortunate series of events that led up to the debate.
	Mrs. Hurrell came to see me at my Friday surgery in January 2007. I was so concerned by what she told me that, in an attempt to resolve the issue, I wrote to Scottish Provident, offering to meet its representatives. Unfortunately, for reasons best known to themselves, they chose not to take up that offer. Since my initial letter of January 2007, numerous additional letters from my constituent and myself have not brought about a satisfactory and just resolution. Unfortunately, referring the case to the ombudsman also failed to bring about the desired result.
	In October 2003, Mr. and Mrs. Hurrell took out a life assurance mortgage policy. Sadly, some 14 months later, in December 2004, Mrs. Hurrell was diagnosed as being terminally ill with stage 3 category C ovarian cancer. She was told that she had only a few months to live. Once my constituent and her husband had come to terms with the shock of that, they contacted Scottish Provident by telephone to inform them of Mrs. Hurrell's medical condition and to request a claim form. Their first telephone contact with Scottish Provident was made in December 2004, and they were extremely surprised to be informed that they did not have terminal illness cover and that it would not be possible for them to make a claim except in the event of death. They were both devastated by that advice, as they were convinced that the cover was an important part of the policy. I am sure that that undoubtedly added to the worry and distress that they were already suffering.
	A few weeks later, in January 2005, Mr. Hurrell telephoned Scottish Provident to check that the information he had been given was correct. They were again advised that it was not possible for them to make a claim as they did not have terminal illness cover. It is worth noting at this juncture that the telephone calls made in both December 2004 and January 2005 were made well within the 13-week claim period allowed to submit a claim. If Scottish Provident had accepted at that stage that Mrs. Hurrell had terminal illness cover, the claim could have been submitted, considered and determined. In the words of Mrs. Hurrell:
	As Scottish Provident is a reputable company, we took this advice as correct and did not question it further.
	Mrs. Hurrell underwent emergency surgery and a heavy course of chemotherapy. Against all the medical odds, she survived and, although very ill, is alive today.
	Some 20 months after Mrs. Hurrell was diagnosed as being terminally ill, she and her husband received a letter from their mortgage company about the renewal of their mortgage protection plan. Mrs. Hurrell contacted the company, advising it that she would require a quotation without her name on the policy. Understandably, she was asked why she did not want her name to be on it. When she explained her circumstances, the staff member at the mortgage company was surprised and, having checked the policy, advised her that she was indeed covered for terminal illness and should contact Scottish Provident immediately.
	On 19 September 2006, Mrs. Hurrell rang Scottish Provident about the advice given in December 2004 and January 2005. The lady to whom she spoke was extremely apologetic about the advice, and said that she would send a claim form without delay. She then asked Mrs. Hurrell when she had been diagnosed. Having given the date of the diagnosis, Mrs. Hurrell was told, Sorry, you are too late. You had to die within the first 12 months. Apart from anything else, that was a terribly callous statement. However on 23 September 2006, Mrs. Hurrell received a letter from Scottish Provident apologising for the incorrect advice and confirming that terminal illness cover was included in death benefit. Enclosed in the letter was a claim form and a request that it be returned along with the original policy document. If the claim could then proceed, Scottish Provident would contact the relevant doctors.
	After numerous letters from Scottish Provident indicating that it was awaiting a response from Mrs. Hurrell's consultant, a further letter arrived on 5 January 2007 notifying Mrs. Hurrell of the failed outcome of her terminal illness claim. It stated:
	Our definition of terminal illness against which your claim was assessed requires that life expectancy is no greater than twelve months.
	It is also worth noting that Mr. Naik, a consultant gynaecologist and oncologist based at Queen Elizabeth hospital in Gateshead, had written to Scottish Provident on 27 November 2006 stating:
	I can confirm that when Mrs. Hurrell originally presented to us with her diagnosis of ovarian cancer she was in a desperate condition requiring emergency surgery, following which she had a number of severe complications. Her life expectancy at that time was certainly less than twelve months.
	To me it is abundantly clear that when she made the initial contact with Scottish Provident in December 2004 and January 2005, Susan's condition was such that she met the requirements of the policy: that is, life expectancy was no greater than 12 months. Consequently, in my opinion she should have been paid in full.
	Susan wrote complaining about the decision, and received a response on 23 January 2007 telling her that she had not informed the company within the required 13-week period, and that the medical information did not support her claim. Given that Scottish Provident had written to her four months earlier apologising for the fact that she had been given incorrect advice about terminal illness cover, it seems strange that it should now say that she had not informed it within 13 weeks. In fact, she had informed it twice. The letter from Mr. Naik, her consultant, was devastatingly clear: she would not survive for 12 months. How can the company possibly claim that there is no medical evidence to support the claim?
	The chief medical officer for Scottish Provident said that, in any event, the company would have waited to discover the outcome of the surgery and chemotherapy before deciding whether to meet the claim. Surely the main reason for taking out terminal illness cover is to enable people to put their finances in order before they die, and payment should consequently be made as soon as the prognosis of life expectancy of less than 12 months has been delivered. If it was normal practice to defer an assessment of terminal illness until after the response to chemotherapy was known, the company was in effect waiting for a person to die within the 12 months before paying out. Why on earth then are people paying the extra for terminal illness cover? If the company is delaying claims of that nature by more than 12 months, it is doing so deliberately to deny customers their rightful payments. It would be interesting to know how often Scottish Provident has applied that practice, and how many claimants have been denied terminal illness payments as a result. It is worth noting also that the basis of Mrs. Hurrell's claim was the medical assessment of Mr. Naik, who is an eminent consultant. The basis of Scottish Provident's case is not what it did, but what it said it might have done at the time; it is based purely on hindsight. If the claim had been accepted, Mr. and Mrs. Hurrell would have been entitled to receive a lump sum benefit of 60,000. Instead, she was offered 150 for her distress and inconvenience.
	Subsequently, Mrs. Hurrell sought the assistance of the financial services ombudsman. Unfortunately, that was without success, as the adjudicator concluded that she could not recommend that the complaint be upheld. As part of her findings, the adjudicator stated:
	I believe that it would have been reasonable for Scottish Mutual to await your response to treatment at the time.
	I am both bitterly disappointed and amazed at that finding. In my view, to defer an assessment of terminal illness until after treatment is contrary to Scottish Provident's own stipulation, which states that someone must be suffering from a terminal illness with a life expectancy of less than 12 months as diagnosed by the attending consultant. It is my view that Scottish Provident, backed by the ombudsman, is deliberately breaking the rule and spirit of its own policy, as nowhere does it state it must wait and see.
	The UK insurance industry is the largest in Europe and the third largest in the world. I am not suggesting that this case in any way reflects on an industry that rightly prides itself on the quality of its products. I hope that this case is a rarity and no one else has had to suffer what Mrs. Hurrell has gone through.
	Scottish Provident is the brand name of Scottish Mutual Assurance Ltd. On its website it describes itself as one the leading providers of life, terminal illness, income protection and unemployment cover. It states that it has a track record that can be trusted, concluding with the statement that since 1996 it has consistently paid out on claims. This certainly is not the case for Mrs. Hurrell. Frankly, the company has behaved disgracefully by first misinforming Mr. and Mrs. Hurrell that they were not coveredit did that not once, but twiceand then refusing to pay what was an entirely legitimate claim and offering an insulting 150 for her distress and inconvenience, instead of paying out the 60,000 she was entitled to.
	Mrs. Hurrell's situation is not good. The disease returned some months ago and she has been very ill. This has been an extremely traumatic period for Mrs. Hurrell and I cannot help but believe that the anxiety, distress and pressure that she has had to deal with as a result of the dispute with Scottish Provident will have had a detrimental effect on her health. When Mr. and Mrs. Hurrell took out the terminal illness cover, they will have hoped that it was a claim they would never have to make. Sadly, that proved not to be the case. It appears as if Scottish Provident has been determined to prevent this claim from being successful. However, even at this 11th hour I hope that Scottish Provident will take positive action to resolve this claim in favour of Mrs. Hurrell. I also request that my hon. Friend examines the regulations pertaining to insurance companies with a view to ensuring that there is greater clarity and protection for customers and preventing insurance companies from taking advantage of the often ambiguous wording of their policies. Mr. and Mrs. Hurrell did everything responsibly, including ensuring that they had adequate insurance cover. I ask my hon. Friend the Minister to join me in calling on Scottish Provident to pay Mr. and Mrs. Hurrell, even at this late date, the full amount of the policy that they are entitled to.

Angela Eagle: I congratulate my hon. Friend the Member for Wansbeck (Mr. Murphy) on securing this debate on an extremely important and particular casehe outlined it in great detailthat also gives rise to general issues regarding the way that insurance is regulated.
	I want to start by saying how sorry I am to hear of Mrs. Hurrell's illness, which on its own must have made the past few years incredibly difficult. I am sure that the frustrations, which my hon. Friend has outlined, with her insurance policy and with the Financial Ombudsman Service have only added to her distress. I certainly hope that the company has been listening extremely carefully to my hon. Friend tonight.
	What happened to Mrs. Hurrell demonstrates that although insurance is a hugely important product that can provide customers with peace of mind as well as financial protection, it can also be complex. It is important that all customers know what they are buying, and that they are appropriately informed by the professional services that the insurance industry brings to bear on products that it has sold. This is one reason why the Government replaced the confusing collection of financial service regulators, complaint adjudicators and compensation schemes that we inherited in 1997 with the Financial Services Authority, the financial services compensation scheme and the Financial Ombudsman Service.
	The FSA is now responsible for the regulation of the insurance industry and has laid down detailed rules on all aspects of the conduct of business of regulated firms. In a constantly evolving market, however, as my hon. Friend demonstrated, rules-based regulation can often lag behind new products or circumstances. That is why the FSA is moving toward more principle-based regulation, instead of specifying detailed processes to be performed. This means being clear about the required regulatory outcomes, and then using supervision and enforcement to ensure that they are achieved. The new, simplified conduct-of-business rules that the FSA published in November, and for the insurance sector specifically in January, take this approach. That does not mean that the rules have been relaxed, however. The FSA also took the opportunity to require firms to take reasonable steps to establish that customers would be eligible to make a claim under a particular policy, and to ensure better standards of disclosure, so that consumers can make more informed decisions.
	This approach is also reinforced by the general principle that firms must treat customers fairly. Obviously, firms should be doing that already, and I will leave it for others to judge what has happened in this instance, but by the end of the year, firms will have to be able to demonstrate to themselves and to the FSA that they are consistently treating their customers fairly. In particular, they will need to demonstrate that customers are provided with clear information and kept appropriately informed before, during and after the point of sale, and that any advice is suitable and takes account of their circumstances. Again, whether this has been achieved in this very difficult instance is for other people to judge.
	On Mrs. Hurrell's specific case, let me say again that I am sorry to hear of the difficulties that she has had with her health and, as a consequence, with the insurance policies that she took out and with the Financial Ombudsman Service, on top of her illness. I think it best, given the information that my hon. Friend has put before the House tonight, if I invite him to write to me with more details and specific dates. I will certainly refer this case to Hector Sants, the FSA's chief executive, asking him to get in touch with my hon. Friend to explain the impact of such regulations. I also want to write to the Association of British Insurers' director-general, drawing attention to this case and asking him to take Mrs. Hurrell's experience into account when the industry reviews, in the 12-month period to 2009, the definition of terminal illness that is used across the whole insurance industry, to see whether changes can be made that might make the definition more understandable for everybody concerned.
	I also wish to contact the Financial Ombudsman Service again, given some of the details that my hon. Friend has put before the House tonight, so that it can check whether it has got everything right in its adjudications so far. If my hon. Friend will write to me soon, I will ensure that I get the letters sent to the appropriate people to see if there is any way forward in this case.
	I also hope that the insurer has listened to what my hon. Friend has to say. If it wished, it could take the matter forward to a satisfactory conclusion, although that is of course a matter for it and not for me. However, I can assure my hon. Friend that I will make inquiries to see whether anything else can be done in these very particular circumstances to make any progress in Mrs. Hurrell's unfortunate situation.
	 Question put and agreed to.
	 Adjourned a ccordingly at five minutes to  Ten o'clock.
	Correction
	 Official Report, 7 February 2008: In column 1217, delete  Amendment made: (e) ... [Mrs. May.] and insert the following:
	 Amendment made (e): in line 63, at end add
	(9A) The Committee, and every such sub-committee, shall sit in public unless it determines otherwise in relation to a particular meeting or part thereof..'. [Mrs. May.]